Action Center / Application for Septic System (Mound, Presby or Infiltrator ATL) / Morgan County, Indiana

Date*

MonthDay Year,

Owner Name:

Owner Phone:

Phone Area Code-Phone 3-Phone 4 ext Extension

Site Address:

Address

City

State

ZIP

Zip-Zip +4
Second portion of ZIP Code is optional.

Installer Information

Installer's Name*

Installer's Phone:

Phone Area Code-Phone 3-Phone 4 ext Extension

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/*

Yes

Number of Bedrooms:

Loading Rate (gpd/sq.ft.):

Total Square Feet:

System Type:

Mound

Presby

Infiltrator ATL

Other

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:

Does 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?

Yes

No

ï»¿**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:

Upslope Curtain Drain with Aggregate:

Perimeter Drain Encircling Absorption Field with Aggregate:

P/I-Socked Tile:

Yes

No

P/I Drain Depth (in):

Sand Mound Dimensions

Basal Area (ft):

Please Do Not Complete The Following Field

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