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Home My WebLink AboutSKY RIDGE LT 18Sky Ridge Lot 18 #015-275-18 Legal Description Development Services Department Pump Installation Date: _ 2 -� A Building Safety Division Pump Manufacturer's Name: l rL.n d ,�- 3 On -Site Water & Wastewater Program s �� Pump Size 3h hp 4700 Elmore Road Pitless Adapter Manufacturer's Name: a °t+ �j8� g-/0 P.O. Box 196650 4 ` Mark Begich Anchorage, S A E T Y 9 - AK 99507 Mayor www.muni.org/onsite Pump Installer Name: Johnny Kay (907) 343-7904 Pump Installation Log Well Drilling Permit Number:fAV. IV A Date of Issue: N Parcel Identification Number: Legal Description Property Owner Name & Address: At - Pump Installation Date: _ 2 -� A Pump Intake Depth Below Top of Well Casing:; OL) feet Pump Manufacturer's Name: l rL.n d ,�- 3 Pump Model: 5 5 qE ( _2 - _2_ �>v Pump Size 3h hp Pitless Adapter Burial Depth: 1-! feet Pitless Adapter Manufacturer's Name: a °t+ �j8� g-/0 Adapter Installer: IV)k Pitless Well Disinfected Upon Completion? T Yes ❑ No Method of Disinfection: CA, Ia,, A -e, b 5 Comments: Pump Installer Name: Johnny Kay Hefty Drilling, Inc. Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. `'SSE FOLD FO2,Ni i RETURN TO: Division of Geological and Geophysical Surveys 3001 Porcupine Drive STAPLE O R 7� Anchorage, Alaska 99501 1 I'll WATER WEL=C' R E.00 0 %x- c�q4 OriI1ing Company Name F'Qs � � r r.Irl Drilling Permit Number I LOCATION OF WELL OWNER NO. STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES Borough 'subdivision Loc 9 Block Fraction Section No. -�/ Town / a /V N/S Ran ge1, / W E/W Merid.an Distance and Direction from Road•lntersections Street Address and Area of Well Location 3 OWNER OF WELL. 1 f Address: 4 l7 v ,rl / Jo rt) j D I^ . / ✓ A.1'') O r D,D ej 9 2 WELL LOG Ft. below Thickness surface of Material Type Top Bottom Stratum 4 WELL DEPTH: (completed) p� ft. Surface Elevation Date of Completion — — / ALVMBowl5 Z Cable tool Rotary Driven, Oug 11 Auger Jetted Bored : Other: Sun I IV C41nj 13ryi. .S 6 USE:Domestic a Publtc Supply Industry Irrigation Recharge Commercial ' E]Test Well Other: ba'r g- 1 W CASING: Threaded ® Welded Height: Above13 Below . Iry_In. to �2 JA t. Depth surface ~ ft. In. to ft. Depth weight �- lbs/ft. DriveShoe? Yes []No I -VI VM E —/ V 14 9-1 a _ 8 FINISH OF WELL: Type: OfRg — eJ 7 Diameter: b . Slot/Mesh Size Length Set between ft. and ft. Fittings: 9 STATIC WATER LEVEL: 1131) t. 1_j above 14 below land surface Type of Measurement KF i y cu 10 PUMPING LEVEL below land surface Go- L 7-Q ft. after rs. pumping g.p.m. ft. after hrs. pumping P.P.M. WELL HEAD COMPLETION: �In Approved Pit Pitless Adapter 11" Above Grade Of Ge )logical %41,urveyII 12 GROUTING: Well Grouted: Yes No Material: Neat Cement 11 Other: 13 SANITARY: Nearest Source of Possible Contamination Feet Direction Type Well disinfected upon completion Wyss No 14 PUMP: (if available) MP Length of Drop Pipe ft. capacityg.p.m. Type: Submersible Other: 1 Jet EIReciprocating 15 REMARKS: Elevation, source of data, water quality tests, etc. 16 WATER WELL CONTRACTOR'S CERTIFICATION: This well drilled under myJ risdictlon and this report is true to the best of my knowledge and belief: Ss� r egistere Business Name Contract License umber Address: Signed: Date Authorized Representative Form 02-WWR MUNICIPALITY OF ANCHORAGE Development Services Department `- : Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-275-18-000 Expiration Date: Legal description SKY RIDGE LT 18 Site address 11154 SKY RIDGE DR Anchorage AK 99516 10/15/2025 Current property owner(s) JAMES & JANE DUBBINS JOINT REVTRUST X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: 0 bedrooms, with the following stipulations: Original Certificate Date: 10/31/2024 his Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF Development Services Department \. / On -Site Water & Wastewater Section \' -- Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-275-18 Complete legal description Sky Ridge Lot 18 Location (site address) 11154 Sky Ridge Drive Current property owner(s) James & Jane Dubbins Joint Revocable Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑■ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 2 SO Date of Payment I v ?� `f -zi; Z % COSA # OSC,Z`-1 )LI -313 Waiver Fee $ Date of Payment Waiver # COSA Application—June 2022 COSA Checklist_June 2022 COSA Checklist Legal Description: Parcel ID: If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank Date of pumping Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Adequacy test date Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in Comments/Deficiencies: E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ■❑Yes if No ft ❑E Yes if No ft Neighboring Tank > 100' ❑■ Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' ❑C Yes if No ft Holding Tank > 100' ❑■ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft ❑■ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ■❑ Yes if No ft ❑■ Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' Yes if No ft Tank to Property Line > 5' ❑ Yes if No ft Wells scent Lots: Field to Property Line > 10' E] Yes if No Private Wells > 100' El Yes if No ft Water Main > 10' s if No ft Community Wells > 200' ❑ Yes if No ft Water Serye > 10' ❑ Yes if No ft F. ENGINEER'S COMMENTS Lot served by public sewer. If tank or field is under driveway comment below G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC & MOA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail, and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore, we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. y_�►j, Name of Firm Pannone Engineering Services Engineer's Printed Name Steven R Pannone P.E., F. ASCE COSA Checklist June 2022 Phone 907-745-8200 Date 10/22/24 Lot 18, Sky Ridge Subdivision Land Surveying Land Development Consultants Subdivision Specialists Construction Surveying 124 E 7th Avenue Anchorage, Alaska 99501 (907) 306-8104 mail@S4AK.com AKCAN 173042 Group S4 Asbuilt 10/09/2024