Fulton County Health Department
125 E 9th St.
Craig Bugno, MD
Rochester, IN 46975
Health Officer
(574) 223-7730
Fax (574) 223-2335
Conventional Onsite Sewage disposal system
DESIGN SUBMITTAL
This gives you some information that will be requested on the sketch and the design
submittal. It is not a substitute for knowing the code. There are supplemental checklists for
other system types
A. Sketch – reminders on items to note
1. Property boundaries and dimensions - Recommend a plat
2. Boring Locations
3. Slope
4. Footprint of all existing or proposed structures – including driveways
5. Compass directions (at least North)
6. Well location including any neighbors
a. Federal loans like 100 feet separation
b. Compression fittings on sewer pipe within 50 feet of well
i. If this situation occurs make a special note of pipe and all it numbers.
7. Sketch of the system including a cross section or use extra sheet for x-section
a) You need to go to the lot and be sure it will fit and check elevations
b) You will need to show details of the system on the sketch,
8. Elevations (laser or transit almost a must)
 Elevations (at least) four corners for system 18 inches or less in depth and
non-traditional systems including drainage
 Elevations recommended on all systems
9. Drainage characteristics- tiles, swells, areas that concentrate water, bodies of water.
10. Jetted tubs of 125 gallons or more?
11. Fall in the pipe should be noted
12. Will there be a sump pump, roof drains? Should not be hooked into the septic –If
needed a basement laundry is to be hooked into the septic with its separate sump
13. Will there be a garbage disposal? Not recommended.
B. Piping - code uses ASTM # it is:
1. Solid Pipe – ASTM #
a) (PVC) D 2665 D 3034
F 891
b) (ABS) D 2661 D 2680
D 2751
c) Pressure Sewer *
D 2241 - 89
1785- 89
1527 - 89
2282- 89
d) 0r waterworks grade ductile iron pipe * (*compression fittings)
2. Absorption field pipe (perforated)
a) PVC ASTM D 2729 -89 ABS ASTM F 810 -89
i. Joints to be glued or other secure connection
ii. Holes to be 120 degrees apart – either two or 3
iii. Pipe is to placed with holes at 4 and 8 o’clock position
b) Chamber system – experimental at reduced sizing
c) Stoneless pipe ASTM F667
Page 1 of 3
Fulton County Health Department
125 E 9th St.
Craig Bugno, MD
Rochester, IN 46975
Health Officer
(574) 223-7730
Fax (574) 223-2335
______________
Sketch checklist
C. General Information
1. General contractor/builder
2. Septic contractor – if out of county address and phone #
3. Owners
4. Number of bedrooms
__________
5. Number of jetted tubs over 125 gallons ___________
6. Garbage disposal
7. Sump pumps
D. Wells
1. Separation distance to closest component of the septic system ____________
2. Neighbor’s well separation distance to closest component of the septic ______
3. Well should be 50 feet from property lines
E. Residential pipe from house to septic tank
1. Sewer pipe ASTM ______ see approved piping or list from the code for details
2. Length from house to septic tank _______________________________
3. Joint between residential sewer pipe: No joint or
Glued,
Compression Gasket*,
Mechanical*, Waterworks grade ductile iron pipe*
4. Positive fall from house to septic tank:
 (4 to 36 inches in 25 feet) or (2-36 in 25 with 6 inch pipe)
F. Septic Tank
1. Tank capacity (size):
2. Manufacturer
(pump tank see supplemental sheet)
G. Delivery Pipe to D-Box
1. Sewer pipe ASTM ______ see approved piping or list from the code for details
 Length ______ Positive fall and watertight
2. Joint:
No joints
Glued
Compression Gasket
H. Distribution Box
1. Note it is to be installed level on undisturbed ground
2. Material: Concrete
Polyethylene
Supplier___________________
3. Baffling Elbow
other __________
4. Number of Outlet holes ____________ Watertight connections
5. At least 5' of gravity sewer pipe (backfilled with dirt) ASTM__________
Page 2 of 3
Fulton County Health Department
125 E 9th St.
Craig Bugno, MD
Rochester, IN 46975
Health Officer
(574) 223-7730
Fax (574) 223-2335
------------------------------------------------------I. Gravity Absorption System (sketch
numbers correspond to numbers below)
1. Number of trenches: _____
2. Separation distance _____
3. If a stone system – amounts
a. Top of pipe ________
b. Pipe __________
c. Below the pipe
4. Synthetic Fabric: Yes No
5. Trench width ___________
6. Trench Depth______________
7. Trench length ______________
8. Final Depth cover __________
9. Square feet
10. Aggregate Type: Washed Gravel
Washed limestone (> 3 on Mohs hardness scale)
11. Lateral pipe 4": PVC ASTM D 2729 ABS ASTM F 810 (Holes at 120 and 240)
12. Determine level ( trench bottom – pipe) by Laser
Transit
Other (explain)
13. Absorption field follows contours
Yes ___ No ____
14. Soil will be rolled tested and construction - delayed if needed Yes_____ No_____
15. If Chambers:
Manufacturer________________ Model # _______________
Number of pieces _____________
 If reduced size
a) 100% replacement area Yes ____ No _____
b) replacement soils ok
Yes _____ No ______
c) Warranty attached
Yes _____ No _____
16. If Stone less pipe
Size 8
10 inches
APPROVED AS SUBMITTED;
Revised 9-03
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Yes _______
NO___________