Eljen GSF A42 - Page 53

13.0 Indiana GSF Registration Form
INSTALLED BY: DESIGNED BY:
NAME NAME
COMPANY COMPANY
A
DDRESS
A
DDRESS
TELEPHONE TELEPHONE
INSPECTED BY: SITE LOCATION:
NAME NAME
COMPANY COMPANY
A
DDRESS
A
DDRESS
TELEPHONE TELEPHONE
MODULES USED B43 (48in x 36in x 7 in) A42 (48in x 24in x 7 in)
(Circle One)
NUMBER OF BEDROOMS 1 2 3 4 5 (Number Greater than 5) ____
(Circle One)
DAILY DESIGN FLOW: Number of Bedrooms x 150 gpd= ____________
SYSTEM CONFIGURATION: Subsurface Bed Above Grade Bed Trench Elevated sand
mound
(Circle One)
Subsurface requires 6 inches of sand beneath module
Elevated sand mounds and above grade beds requires 12 in of sand beneath module
TYPE OF SYSTEM: Gravity Pressure Dosed
(Circle One)