180 S. Main St., Ste. 252, Martinsville, IN 46151

765-342-6621, Fax: 765-342-1062 morgancohd@morgancountyhealth.com

Online Application for Septic Permit (Conventional Systems)

Septic Installer Information for Trench Systems

Date:*
Owner Name:
Owner Phone:
-
Owner's E-mail:
Site Address:
Installer's Name:*
Installer's Phone:*
-
Installer's E-mail:*

By checking the box below, I hereby certify that I am the installer named above and that I am authorized to request a permit for the above property, in accordance with Indiana Code 410 IAC 6-8-3.

I agree with the above statement.
Number of Bedrooms:
Water Supply Source:
Trench System Type:

Sewer Pipe:

ASTM-
SDR-
Length (ft):

Septic Tank:

Septic Tank Size (gal):
Septic Tank Manufacturer:
Septic Tank Material:

Dose Tank:

Dose Tank Size (gal):
Dose Tank Manufacturer:
Dose Tank Material:

Effluent Pump:

Pump Manufacturer:
Pump Model:
GPM:
Static Head:
Friction Loss:
TDH:
Dose (gal):

*All pump electrical connections make be completed inside a NEMA 4x junction box.*

Force Main:

F.M. ASTM-
F.M. SDR-
F.M. Diameter (in):
F.M. Length (ft):
Pumping Uphill?

Distribution Box:

Number of Holes:
D-Box Manufacturer:
D-Box Material:

Absorption Field:

Type:

*If Chamber or Other, please indicate Manufacturer and Model below:

Manufacturer:
Model:
Number of Trenches:
Trench Length:
Trench Width:
Trench Depth:
Total Square Feet:

Drainage:

Site Slope (%):
Water Table Depth (in):
Drain depth (in):

Drainage:

Drainage Type:
Socked Tile:
Drain Outlets to:
Other Information Pertaining to this System:
Word Verification: