Morgan County Health Department
180 S. Main St., Suite 252
Martinsville, IN 46151-1988
Phone: 765-342-6621 Fax: 765-342-1062

 **Septic Installer Information for Mound and Presby Systems**

 
Owner Name: ______________________________ Phone: ____________________________

Site Address: __________________________________________________________________

Installer’s Name: ___________________________ Phone: _____________________________

Installer’s Signature: _______________________ Date: ________________________

# Bedrooms: ____           Loading Rate: ____(gpd/sq.ft.)           Total Square Feet: ___________

System Type:      Mound ____            Presby ____ (Move to Presby Section)

 
Sand Mound

Sewer Pipe:     ASTM- ____          SDR-____          Length ____(ft)

Septic Tank:     Size ______ (gal)          Manufacturer ____________          Material___________

Dose Tank:     Size ______ (gal)          Manufacturer ____________          Material___________

Effluent Pump:     Manufacturer ________________          Model _______          GPM ________
Design Head ________ Static Head _______ Friction Loss _______ TDH _______
Dose _____gal

Force Main: ASTM-____ SDR-____ Diameter _______ Length __________(ft)
Pumping Uphill? Yes ___ No ____

Dimensions:     Basal Area ____x____(ft)          Gravel Bed ____x____(ft)

Manifold Diameter ____          # of Laterals ____          Lateral Length ____

Lateral Diameter ____          # of Holes ____

Drainage:     Site Slope ____%           Water Table ____          Depth ____

Drainage Type: Upslope Curtain Drain with Aggregate ____
                            Perimeter Drain Encircling Absorption Field ____

 Presby System

If dosing, fill in the Dose Tank, Effluent Pump and Force Main Sections above. 

Bed Dimensions: ____x____          # of Pipes ____          Length of Pipes ____

Depth of Bed: ______ Slope across Site: _______%

Drainage Type:     Upslope Curtain Drain with Aggregate ____
                                 Perimeter Drain Encircling Absorption Field ____