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

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

Online Application for Septic System (Mound, Presby or Infiltrator ATL)

**Septic Installer Information for Mound, Presby or Infiltrator ATL Systems**

Date:*
Owner Name:
Owner Phone:
-
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:
Loading Rate (gpd/sq.ft.):
Total Square Feet:
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:
Pump GPM:
Pump Design Head:
Pump Static Head:
Friction Loss:
TDH:
Dose (gal):

Force Main:

Force Main ASTM-
Force Main SDR-
Force Main Diameter:
Force Main Length (ft):
Pumping Uphill?

**All pump electrical connections must be inside a NEMA 4x junction box**

Presby or Infiltrator ATL System

Bed Dimensions (ft):
Number of Pipes:
Length of Pipes (ft):
Number of Beds:
Depth of Bed:
Slope Across Site (%):

Presby/Infiltrator ATL Drainage:

P/I- Drainage Type:
P/I- Socked Tile:
P/I- Drain Depth (in):

Sand Mound

Dimensions:

Basal Area (ft):
Gravel Bed (ft):
Manifold Diameter (in):
Number of Laterals:
Lateral Length (ft):
Lateral Diameter (in):
Number of Holes:
Site Slope (%):

Sand Mound Drainage:

SM- Drainage Type:
SM- Socked Tile:
SM- Drain Depth (in):
Word Verification: