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EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON FB 24, pg 56-58 BE
UNLESS OTHERWISE NOTED.
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Chain link fence (typ) I Lot 22A-1
Note: Nearest septic vent located on lot 24A-4 is 131.6'± fron well.
REVISED 8-28-24 Added Well
AS -BUILT NO COR S ET HIS DATE
I hereby certify that I have performed a Mortgagee's inspection
in accordance with ASPLS Standards of the following
described property: LOT 22A-5, SHACKLETON
SUBDIVISION
Anchorage Recording Precinct, Alaska, and that the
improvements situated thereon are within the property lines
and do not overlap or encroach on the property lying
adjacent thereto, that no improvements on the property lying
adjacent thereto encroach on the premises in question and
that there are no roadways, transmission lines or other
visible easements on said property except as indicated
hereon.
Dated at Anchorage, Alaska
this 26th day of JULY , 2024.
FRED WALATKA & ASSOCIATES, L.L.C.
Engineers and Surveyors
907-248-1666
This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary
survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to
establish any fence, structure or other improvements unless otherwise noted. This drawing shall only be used for a single property transaction. Use of this
drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross
negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product.
N89052'30"E
Lot 21 A
1 30 1 Lot 22A-5
SCALE: V= 30'
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Lot 22A-3
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Note: Well located on Lot 22A-5 is 131.6'± from nearest septic vent.
REVISED 8-28-24 Added septic vents e*4)
AS -BUILT NO CORNERS SET THIS DATE
I hereby certify that I have performed a Mortgagee's inspection
in accordance with ASPLS Standards of the following
described property: LOT 22A-4, SHACKLETON
SUBDIVISION
Anchorage Recording Precinct, Alaska, and that the
improvements situated thereon are within the property lines
and do not overlap or encroach on the property lying
adjacent thereto, that no improvements on the property lying
adjacent thereto encroach on the premises in question and
that there are no roadways, transmission lines or other
visible easements on said property except as indicated
hereon.
Dated at Anchorage, Alaska
this 26th day of JULY , 2024.
EASEMENTS OF RECORD, OTHER THAN 8' �� ��2t FRED WALATKA & ASSOCIATES, L.L.C.
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON BE Engineers and Surveyors
UNLESS OTHERWISE NOTED_ FB 24-2, pg 56-58 907-248-1666
This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary
survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to
establish any fence, structure or other improvements unless otherwise noted. This drawing shall only be used for a single property transaction. Use of this
drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross
negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product.
OAK' TER ANCHORAGE AREA BORC!!
GREA I ER ANCHORAGE AREA BORvUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6.650
ANCHORAGE, ALASKA 99502
TELEPHONE 279-8686
SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT
NAME OF APPLICANT + L. ,, p ""yi�g��1
INSTALLATION LOCATION " ed
LEGAL DESCRIPTION
INSTALLATION OF: SEPTIC TANK ,
PERMIT NO. 169,3
MAILING ADDRESS � �'" r+zAVV PHONE
GE PIT DRAIN FIELD , OTHER
TYPE AND SIZE OF FACILITY
,,},TO�BE SERVED �'�` '-
TO
FINANCED THROUGH TO BE INSTALLED BY
SOIL TEST RESULTS NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE TYPE
MINIMUM DISTANCES, REQUIREMENTS
r
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT
;Z0
i
If
DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL ry
� f
SEPTIC TANK $7SEEPAGE PIT DRAIN FIELD
��Jf
SEEPAGE AREA SIZE/ TYPE I GJ
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK V Q SEEPAGE PIT
DRAIN FIELD ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK
SEEPAGE PIT
DRAIN FIELD
i �
SEPTIC TANK, 1:41iSEEPAGE PIT 5 V DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITT�Fo WITH AIRTIGHT RFMOVAB LE
S.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
HEALTH AUTHORITY
OR
LICENSED DESIGNER
DIAGRAM OF SYSTEM
1 CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE
DESCRIBE ZM IS IN ACCORDANCE WITH SAID CODE.
DATE / APPLICANT'S SIGNATURE
j7
ET
Performed For T. L. Cobb Dato Perfor-ed 6/25/71
--Ot Shackelton
Tbis Fr�-.r-m Rlp-,;Orts. �,F `—er: 1,-1 1:., - 0,
Depth Lot No. 22-A-4 and 22-A-5
I sketell
Ch -a
eet
brown clayey and sandy
silt
2
3
gray sand and fine gravel,
4 well graded
(GW)
5
i—QU
6
7 '-4 T f-- fli
8
9 --j
was Ground watery'
F r c o o 'd I C, LO
t
COMIMVNTS85 square feet of- drainage, r
back fill except gor_t e uRpp
Test Performed '3*YT.,_.R.
Csar:lisl,�,.__„a
Data Certified National Testing Services, Inc.
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f
F r c o o 'd I C, LO
t
COMIMVNTS85 square feet of- drainage, r
back fill except gor_t e uRpp
Test Performed '3*YT.,_.R.
Csar:lisl,�,.__„a
Data Certified National Testing Services, Inc.
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
OSC261128
Parcel ID 016 -141-45
Legal description SHACKLETON LT 22A-5
Expiration Date: 4/27/2027
Site address 11323 LILLIAN LN
Current propertyowner(s) COBB TILFORD L & DOROTHY E
X The On-site system(s) is/are approved for 3 bedrooms
By:
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
Original Certificate Date:
5/18/2026
This Certifitate 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,
Deve opment Service 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 submittal.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
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 Application
1. GENERAL INFORMATION
Parcel I.D. 016-141-45
Complete legal description SHACKLETON LOT 22A-5
Location (site address) 11321 LILLIAN LANE ANCHORAGE, ALASKA 99515
Current property owner(s) COBB TILFORD & DOROTHY
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
Day phone
3. TYPE OF WATER SUPPLY: ❑■ Private Well serving # 1 dwelling units
❑ Other Non-public well as regulated by MOA ❑ Water Storage
❑ Community Well or Public
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 54 - See advisory if steel or fiberglass 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 $ U Waiver Fee $
Date of Payment r' 2! n Z b
COSA # b C Z I/
Date of Payment
Waiver #
COSA Application_Apr2025.doc
COSA Checklist
Legal Description: SHACKLETON LOTS 22A-4 & 22A-5 Parcel ID: 016-141-44&016-141-45
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 CIRCA 1971* Total depth 410* ft
Cased to UNKNOWN ft
® Sanitary seal is functioning correctly
® Wires are properly protected
Casing height (above ground) 32 in.
Date of flow test for COSA 8/8/24
Static water level at beginning of test 37 ft.
Comments *Per inspection report data and date
B. TANK DATA
Measured operating fluid level in septic tank 42"
Date of pumping 8/7/24 — VACANT SINCE PUMPING.
❑ Required maintenance completed, if AWWTS
Comments: Fluid levels appear to be oDeratina normally Der
concrete tank / MOA record documents.
D. DISPOSAL FIELD DATA
Which system tested (date installed) 7/6/1971
® ALL standpipes present per record drawing
Total measured depth from grade 9_3 ft (max)
Measured depth to pipe invert from grade 4_8 ft (min)
(Top of Crib)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
❑ Monitor tubes (MT) go to bottom of effective (ED).
If not, state depth into effective 4.5 ft
❑ Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced 2000 gallons 8/7/24 date
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Well production at time of test 4 gpm
Water storage tank volume None gallons
Well disinfected for coliform test? ❑ Yes ® No
® Coliform bacteria is Negative
Nitrate mg/L ® Nitrate less than MRL (ND)
Arsenic 7.20 ug/L ❑ Arsenic less than MRL (ND)
FWf 5
Collected by Date 04/27/2026
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 8/8/24
Results F� Pass
Fluid depth prior to test 8 in
Water added 450 gal
New fluid depth 18 in
Elapsed time 1440 min
Final fluid depth 1 in
Absorption rate 450 gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 72 in (Moa 6' ED)
Effective depth (ED) used 19 In (Missing ED + Final Fluid Depth)
Effective depth remaining 53 in
Comments/Deficiencies: Approximate total measured depths from existina grade. ED per elevation measured shots &
appears approximately 1.5' (18") ED is missing — not measurable. The MT was dry 04/27/2026. No foundation cleanout found
for this older septic system & maintenance if needed would be from interior plumbing or require other action.
COSA Checklist.docx
E. SEPARATION DISTANCES
From Well on Lot to: (Please enter distances if less than required)
Septic Tank/Lift Station on Lot > 100'
Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
® Yes
if No ft
Neighboring Tank > 100' ® Yes
if No
ft
Sewer Service/Septic Line > 25'Z Yes
if No ft
Disposal Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No ft
Neighboring Disposal Fields > 100'
Animal Containment > 50' ® Yes
if No ft
® Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Sewer Line/Main > 100' ® 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 Disposal Field(s) on Lot
to: (Please enter distances if less than required)
Tank to Foundation > 10' ® Yes
if No
ft
Surface Water > 100' ® Yes
if No ft
Field to Foundation > 10' ® Yes
if No
ft
Wells on Adjacent Lots:
Tank to Property Line > 5' ® Yes
if No
ft
Wells > 100' ® Yes
if No ft
Field to Property Line > 10' ® Yes
if No
ft
Community Wells > 200' ® Yes
if No ft
Water Main/Service Line > 10' ® Yes
if No
ft
If tank or field is under driveway comment below.
F. ENGINEER'S COMMENTS
This is 2 lots with the well on Lot 22A-5 and the septic on Lot 22A-4 with one pipe for the concrete septic tank
& one for the crib.
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.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Engineer's Printed Name CURTIS HUFFMAN, PE Date 05/11/2026
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting & FWi 5
COSA Checklist.docx
OF A4
*: 49 TM .....•:*
Curtis Huffman j �F�i•.• CE 128991 •-•�ti-/
05/11/26
2024-013177-0
A Recording Dist: 301 - Anchorage
S 5119/2026 01:48 PM Pages: 1 of 2
• IIIIIIIIIIIII IIIIIII
Stewart entl
After recording return to Grantee
2910793 STA
ACCESS AND MAINTENANCE AGREEMENT
This Access and Maintenance Agreement ("Agreement") is made and entered into by and
between:
The undersigned Owner of Lot 22A-4 ("Grantor"), mailing address is 1409 Summit View St.,
Anchorage, AK 99504, and
The undersigned Owner of Lot 22A-5 ("Grantee"), mailing address is 1409 Summit View St.,
Anchorage, AK 99504
Grantor and Grantee may be referred to collectively as the "Parties."
The purpose of this Agreement is to grant the Grantee a perpetual, non-exclusive right of access
over and across Lot 22A-4 for the inspection, maintenance, repair, replacement, and operation of
the septic system serving Lot 22A-5, which is physically located on Lot 22A-4.
• Grantor's Property: Lot 22A-4, SHACKLETON SUBDIVISION, according to the
official ptat thereof, filed under Plat No. 70-326, in the records of the Anchorage
Recording District, Third Judicial District, State of Alaska.
• Grantee's Property: Lot 22A-5, SHACKLETON SUBDIVISION, according to the
official plat thereof, filed under Plat No. 70-326, in the records of the Anchorage
Recording District, Third Judicial District, State of Alaska.
Grantor hereby grants to Grantee, and Grantee's agents, contractors, employees, and assigns, a
perpetual, nonexclusive easement over, across, and upon the portion of Lot 22A-4 reasonably
necessary to access, inspect, maintain, repair, replace, and operate the septic system serving Lot
22A-5 ("Easement Area").
The rights granted under this Agreement include:
• Access by foot or vehicle as reasonably necessary
• Inspection of the septic system
• Routine maintenance
• Emergency repairs
eRecorded Document
Installation of updated or code -compliant components in the future
All work shall be performed in a manner that minimizes disturbance to Lot 22A-4
• Grantee is solely responsible for all costs associated with the septic system, including
inspection, pumping, maintenance, repair, and replacement.
• Grantor has no obligation to maintain or contribute to the septic system unless damage is
caused by Grantor's negligence or intentional actions.
Following any work performed within the Easement Area, Grantee shall restore the surface of
Lot 22A-4 to substantially the same condition that existed prior to the work, including soil
grading, vegetation replacement, and debris removal.
Grantee shall indemnify and hold harmless Grantor from any claims, damages, or liabilities
arising from Grantee's use of the Easement Area or maintenance of the septic system, except for
damages caused by Grantor's negligence or intentional misconduct.
This Agreement and the easement rights granted herein shall nun with the land and be binding
upon and benefit the Parties and their respective heirs, successors, and assigns.
Date__ l iq_��
Grantor (Owner of Lot 22A-4):
Amy Marie Duznmann Successor Truee of The Tilford L Cobb and Dorothy E Cobb Living
Trust
Grantee (Owner of Lot 22.A-5):
Amy Marie Dummann Successor Tru of The Tilford L Cobb and Dorothy E Cobb Living
Trust
N 0110 D[I] 3F.11." 11V
THIRD JUDICIAL DISTRICT) ss.
On this // day of May, 2026, before me, the undersigned Notary Public in and for the State of
Alaska, personally appeared Amy Marie Dummann Successor Trustee , known to me or proven
to me on the basis of satisfactory evidence to be the individual(s) described in and who executed
the foregoing instrument, and acknowledged that they signed the same freely and voluntarily for
the uses and purposes stated therein.
Notary Public in d r Otate of Alaska My commission expires: l /z—
STATE
OF ALASKA
NOTARY PUBLIC
s.
II III I I VIII I IIIILauri Schoff
My commission Expires Dec 25, 2026
2 of 2
eRecorded Document 301-2026-013177-0
N89052'30"E
Lot 21 A
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Lot 22A-2
Note: Well located on Lot 22A-5 is 131.6'± from nearest septic vent.
REVISED 8-28-24 Added septic vents e*4)
AS -BUILT NO CORNERS SET THIS DATE
I hereby certify that I have performed a Mortgagee's inspection
in accordance with ASPLS Standards of the following
described property: LOT 22A-4, SHACKLETON
SUBDIVISION
Anchorage Recording Precinct, Alaska, and that the
improvements situated thereon are within the property lines
and do not overlap or encroach on the property lying
adjacent thereto, that no improvements on the property lying
adjacent thereto encroach on the premises in question and
that there are no roadways, transmission lines or other
visible easements on said property except as indicated
hereon.
Dated at Anchorage, Alaska
this 26th day of JULY , 2024.
EASEMENTS OF RECORD, OTHER THAN 8' �� ��2t FRED WALATKA & ASSOCIATES, L.L.C.
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON BE Engineers and Surveyors
UNLESS OTHERWISE NOTED_ FB 24-2, pg 56-58 907-248-1666
This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary
survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to
establish any fence, structure or other improvements unless otherwise noted. This drawing shall only be used for a single property transaction. Use of this
drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross
negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product.
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SCALE: 111= 30'
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N89052'30"E 150.00
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EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON FB 24, pg 56-58 BE
UNLESS OTHERWISE NOTED.
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Lot 22A-3
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Chain link fence (typ) I Lot 22A-1
Note: Nearest septic vent located on lot 24A-4 is 131.6'± fron well.
REVISED 8-28-24 Added Well
AS -BUILT NO COR S ET HIS DATE
I hereby certify that I have performed a Mortgagee's inspection
in accordance with ASPLS Standards of the following
described property: LOT 22A-5, SHACKLETON
SUBDIVISION
Anchorage Recording Precinct, Alaska, and that the
improvements situated thereon are within the property lines
and do not overlap or encroach on the property lying
adjacent thereto, that no improvements on the property lying
adjacent thereto encroach on the premises in question and
that there are no roadways, transmission lines or other
visible easements on said property except as indicated
hereon.
Dated at Anchorage, Alaska
this 26th day of JULY , 2024.
FRED WALATKA & ASSOCIATES, L.L.C.
Engineers and Surveyors
907-248-1666
This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary
survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to
establish any fence, structure or other improvements unless otherwise noted. This drawing shall only be used for a single property transaction. Use of this
drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross
negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product.