St. Joseph County Department of Health

“Promoting physical and mental health and facilitating the prevention of disease, injury,

and disability for all St. Joseph County residents”

FLOOD DOSE WORKSHEET

This worksheet must be accurately completed and submitted with the site plan which demonstrates all aspects of the trench system.

SYSTEM SPECIFICATIONS: See Department of Health specification sheet for information

Soil Load Rate ______ Required absorption area _________ ft² Required gallons per minute ______

Daily Design Flow (DDF): ____ gallons = number of bedrooms/equivalents ___ x 150, or 450 (whichever is

greater)

SEPTIC TANK: New:_____ Existing:_____ Size:________gallons Manufacturer:_________________

DOSE TANK:	New:_____ Existing:_____	Size:________gallons	Manufacturer:________________

Internal dimensions: Width:________inches, Length:________inches, __________gallons per inch or foot

(circle one)

ABSORPTION FIELD: (check one) ___Aggregate/pipe ___Chambers ___Other:____________________

Lateral separation: ______ feet on-center. Minimum trench depth:______” Maximum trench depth:______”

Chambers: Manufacturer: _________________________________ Length per chamber:_______ feet.

Total number of chambers:_____ Number of Chambers per run or trench:____________________________

Trenches: Number:_____ Length:_____ feet. Width:_____ feet. Total square footage:_______________

Bed: Length:_____feet, Width:_____feet, Total absorptive area: _____________square feet.

Additional/Misc. info: ______________________________________________________________________

DISTRIBUTION NETWORK:

Only pressure rated pipe, fittings (couplers, reducers, elbows, tee’s, etc.) will be used. ____Yes ____No

Effluent force main: Length**:_____feet. Diameter:_____inches. Volume*:________(length X volume/foot)

(must be 1” to 4”)

Pipe diameter:	1”	1¼”	1½”	2”	3”	4” Gallons/foot:	.045	.078	.106	.174	.384	.650 * If line drains to the dose tank, this is

drain-back amount to be added to the

actual dose to determine float settings.

**Is any portion of the force main deeper than than 60”: _____yes _____no.

If yes, what length will NOT drain:________feet. (Subtract this amount from the total length before calculating drain-back volume)

Effluent force main drains to:

_______ D-box:	Total dose is DDF	Total dose: __________ gallons

_______ Dose tank:	Total dose is DDF + Drain-back	Total dose: __________ gallons

Drawdown distance:

Pump on/off distance: ______ inch or feet (x) ______ gallons per inch or foot = ________ total dose amount

in gallons.

Friction loss in effluent force main: *Sec. 76 (h) Table IX of Rule 410 IAC 6-8.3.

Friction loss at ________gpm = _________*feet per 100 ft. of _________ inch diameter pipe.

*Pipe diameter:	1”	1½”	2”	2½”	3”	4” 90° Elbow	:	2.6’ 4.3’ 5.2’	6.2’ 7.7’ 10.1’ 45º Elbow:	1.4’	2.1’ 2.8’	3.3’ 4.1’ 5.4’ Check valve:	8.7’ 13.4’ 17.2’ 20.6’ 25.5’ 33.6’

Calculate friction loss from fittings using chart:

List each fitting by type and corresponding value.

Example (for 2”): 2-90° elbows at 5.2’ = 10.4’

Add up total equivalent length for each fitting type to get “Friction loss length from fittings” to use below.

FITTINGS List:

Length force main ______ (+) Friction loss length from fittings ______ = ______ total effective length in feet.

Number from Table IX:________ (x) __________total effective length in feet/100 = ________ Friction loss

PUMP: Manufacturer: _______________________________ Model: ____________ Horse power: _____

Performance curve included with TDH and gpm plotted:	__________ Yes __________ No

Pump is adequate, but not oversized:	__________Yes __________ No

Dosing Tank will be set up in compliance with Sec. 64 and	__________Yes __________ No

Sec. 65 of the State Rule:

Junction box(es) will be located outside the dosing tank and riser, __________ Yes	__________ No

and shall be in accordance with Sec. 65 of the State Rule:

All Septic Tanks and Dosing Tanks will have risers in accordance __________ Yes	__________ No

with Sec. 61-64 of the State Rule:

Each Dose Tank will be equipped with an audible and visual alarm __________ Yes	__________ No

on a separate circuit from the pump:

Pump will stay submerged at all times:	__________ Yes	__________ No

TOTAL DYNAMIC HEAD:

A. Total Friction Loss in Delivery Line =	____________ feet

B. Elevation Difference (Pump-off to D-Box) =	____________ feet

(Or highest elevation in force main)

C. System Design Head =	_____0______ feet

Total Dynamic Head =	____________ feet

(A + B + C)