SelfCertAnnualReportSummry

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City Of Columbus

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Mayor Michael B. Coleman

Department of Public Utilities
Tatyana Arsh, PE. Director

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City of Columbus - Division of Power and Water OEPA SELF-CERTIFICATION ANNUAL REPORT SUMMARY

This form shall be submitted to the Division of Power and Water with all projects that require OEPA approval.

Project Name: DOPW Project No.: Consultant:

1. Construction Cost

$

2.

Actual Service Connections

3. Potential Service Connections 4. Increase in Average Daily Demand
(No. of services multiplied by (130-gpcd x 3 people per household)

GPD

= gallons
GPD

per day)

5. Increase in Peak Daily Demand
(1.5 multiplied by the average daily flow

=gallons

per day)

6. Operating Pressure Range

PSI

Utilities Complex Director's Office Power and Water Division Operational Support Division Fairwood Complex Sewerage and Drainage Division

910 Dublin Road 614/645-6141 614/645-7020 614/645-1508

FAX: 614/645-8019 FAX: 614/645-8177

Columbus. Ohio 43215 TOO: 614/645-6454 TOO: 614/645-7188

1250 Fairwood Avenue 614/645-7175 FAX: 614/645-3801

Columbus. Ohio 43206 TOO: 614/645-6338

The City of Columbus

is an Equal Opportunity

Employer