Installer's Name:

Installer name

Company:

Installer Company

Street Address:

Address

City:

State:

State

Zip:

Property Owner:

Site Address:

City:

State:

Zip:

Inspected By:

Include name, address, and contact information

Designed By:

Include name, company and contact information.

Modules Used:

• B43 (48" x 36" x 7")
• A42 (48" x 24" x 7")
• B23 (24" x 36" x 7")

Daily Design Flow:

Number of Bedrooms x 150 GPD=

System Configuration:

• Subsurface Bed
• Trench
• Elevated Mound

Type of System:

• Gravity
• Pressure
• Flood Dosed

Area Reduction:

Refer to section labeled "notes" below tables 5&6 in manual

Site Slope:

Trench/Lateral Length:

Gravity & Flood dosed systems have a max length of 100 ft.

Perimeter Drain:

• Yes
• No

Venting:

Venting is required if system cover exceeds 18".

• Yes
• No

Comments:

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