Water Quality Division Preliminary Engineering Report Form (Page 2 of 2) in pdf

II. Public Water Supply System

System Name: __________________________________

PWSID Number: ____________

Source of water supply: ___________________________________________

Surface __________ , Ground ________, or Purchase __________

Community _________ or Non-Community ___________

Population served by proposed platted subdivision: ________________________________

Number of service connections (subdivision): ____________________________

Estimated total daily water demand: _________________________________________

System pressure at point of connection: _________________________________________

I, ____________________, the Authorized Representative for the _________________________, certify that _________________

will supply water to the proposed subdivision. The water system is adequate to supply quantity and quality of water to the proposed

subdivision and maintain the minimum pressure requirements of 25 psi at all points in the distribution system at all times.

___________________________________________________________

Signature of Authorized Representative for the Water Supply System

III. Community/Public Sewage System

System Name: ______________________________________________________________

Facility ID Number: S-_______________

Population served by proposed platted subdivision: ____________________________

Number of service connections (subdivision): ____________________________

Total estimated daily sewage generated by the proposed subdivision: ____________________________

I, ____________________, the Authorized Representative for the _________________________, certify that _________________

will receive transport and treat the sewage generated by the proposed subdivision. The Sewage Treatment Facility is adequate to treat

the waste as required by the Oklahoma Department of Environmental Quality.

___________________________________________________________

Signature of Authorized Representative for the Sewage Treatment Facility

IV. Water Quality Division

Reviewed By:

_______________________

Position: _________________________

Date Approved:

________________________

Signature: __________________________

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Water Quality Division Preliminary Engineering Report Form Page 2