Water Quality Division Preliminary Engineering Report Form
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1
2Water Quality Division Preliminary Engineering Report Form
for
Subdivision Plat Approval
I. Subdivision/Development Information
1.
Name of development/subdivision: ______________________________
2.
County: ______________________________
3.
Legal Description: ___ /4, ___ /4, ___ /4, of Section ______, T- ___ - ___, R - ___ - ___, I. M. / C. M., ______________
County
4.
Developer: ___________________________________________________
5.
Developer’s address: ___________________________________________________
6.
Developer’s phone number: ___________________________________________________
7.
Water will be supplied by: ___________________________________________________
8.
Sewage will be received, transported, and treated by: ___________________________________
9.
Number of lots (service connections) proposed: ___________________________________________________
10. A location map of the proposed subdivision/development is included? Yes ( ); No ( ). A location map is required.
11. Highest elevation in the proposed subdivision: ___________________________________________________
12. The elevation of the nearest water storage tower: ___________________________________________________
13. Water pressure at the point of connection of the subdivision: ___________________________________________________
14. The proposed waterline system is designed to maintain a minimum pressure of 25 psi at all points under all conditions of flow:
Yes ( ) : No ( )
15. Hydraulic analysis based on flow demands of one gallon per service connection and pressure requirements is used to size all
water mains: Yes ( ); No ( ).
16. Hydraulic analysis is provided (hydraulic analysis is required for the review process): Yes ( ); No ( ).
17. A minimum waterline size of six (6) inches in residential areas is proposed: Yes ( ); No ( ).
18. The normal static pressure throughout the area to be served will range from _______ to _______ psi.
19. The normal dynamic pressure throughout the area to be served will range from _______ to _______ psi.
20. Hydrants are provided at each intersection and at intermediate points so spacing does not exceed 600 feet: Yes ( ); No ( ).
21. Hydrants, with 4 ½ inch pumper outlets are to be connected to mains smaller than 6 inches: Yes ( ); No ( ). If Yes, explain
______________________________________________________________________________________________________
22. Where waterlines and sewer lines intersect the minimum vertical separation (edge to edge) is ________ inches.
23. Proposed waterline extension involves surface water crossings: Yes ( ); No ( ).
24. Onsite inspection of the proposed waterline construction will be inspected by:
Engineering Firm: Yes ( ); No ( ),
Owner: Yes ( ); No ( ), or
Other (please specify): ___________________________________________________
25. The area of the proposed development: _________________.
If area of development is 5 acres or more, has the
developer/builder obtained a DEQ Storm Water Construction Permit: Yes (
); No (
). Developers/builders are required to
obtain a DEQ Storm Water Construction Permit for a construction site that will disturb five (5) acres or more in accordance with
OPDES, 27A O.S. 2-6-201 et siq.
26. One hundred year flood elevation: ___________________________________________________
I certify that, to the best of my knowledge, all the information provided in this engineering report form is correct and no significant
information necessary for a proper evaluation of the project has been omitted:
Signature of Professional Engineer: _______________________________ Date: ___________
Name of Professional Engineer: _______________________________
State of Oklahoma Professional Engineer No: ______________________________
Phone No: _(____)_________________________
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