HomeMy WebLinkAbout5A_090805_As-Built.indd OSTP As-Built Form
Owner:________________________________Parcel Number: ______________________
Street/City/Zip Code:_________________________________________________________________________
Lot: ___________ Section: ___________ Township: ____________ N Range: ____________ W
Installation Date:_______________ Installer:__________________________ License Number: __________
Is the system in Shoreland, serving a MDH facility or in a Wellhead Protection area? YES NO
Number of Bedrooms/ Flow Rate:_________________# / gpd Septic Tanks, No & Size:______________#/gal
Pump Tank Size:_________________gal Tank Manufacturer: __________________________________
Pump Size: _________ hp _______ gpm _______ft of TDH Floats properly set? YES NO
Soil Treatment Area:
TYPE I TYPE II TYPE III TYPE IV TYPE V
TRENCH BED MOUND AT-GRADE WARRANTIED OTHER:______________
Limiting Layer/Depth:________”
Depth from Surface:_________ ”
Media or Slat depth:__________ ”
Trench Width:______________ft
Rockbed Size:_____________________
Adsorption Width:__________________
Sand Depth:_______________________
(under mound)
Describe: __________________
__________________________
__________________________
__________________________
Bottom Square Feet Area:____ft 2
Design Variances:____________________________________________________________________________
Other Information:
List any further system descriptions:
List any material testing results (jar test, sieve analysis, etc):
List conditions during construction:
List who is responsible for establishing vegetative cover:
I hereby certify that I have completed this work in accordance with applicable ordinances, rules, and laws.
________________________________________(Installer) ________________(license #) ___________(Date)
Custom One Homes 0411723420021
2700 White Oak Circle, Orono, MN 55356
Saint Croix Sewer
5 / 750 2 / 1,500 & 1,000
1000 WIESER CONCRETE
0.4 36 16.1
n
12 10'
20'
6"24"
Rock
625
4
BENCHMARK - 100.0'
Threshold of Backdoor of Lowest Level
SEWAGE TANKS
1st Tank Inlet Invert - 96.0'
2nd Tank Inlet Invert - 95.6'
Pump Tank Inlet Invert - 95.4'
MOUND
Rockbed - 10' x 62.5'
Bottom of Rockbed 104.0'
10 ' x 62.5' Rockbed
1,500-gal
1,000-gal
1,000-gal
~63' -
4"
s
e
w
er
~47' - 2" Supply Line
84'-2"
Pump and Alarm Verification Form
Site Address: ____2700 White Oaks Cirlce, Orono ________________________________________
Company Name: __Kloeppner Services & Design_________________ License #: L4043
1. That a representative or I of my company has verified that the Indoor or Outdoor Pump Alarm
sounded by lifting the float switch and the alarm light is on and that the pump was tested with
the float switch.
2. If applicable, that myself or a representative of my company has verified that the Indoor or
Outdoor Filter Alarm sounded by lifting the float switch and the alarm light is on.
Date: October 14th, 2023
Print Name: Jesse Kloeppner
Signed:
Please return a copy of this form to:
chris@midwestsewer.com
Final Inspection and certificate of compliance cannot be issued until this form is received.