APPENDIX B: FORM FOR WATER UTILITY PROFILE AND WATER CONSERVATION REPORT

Customer Water Conservation Report Due May 1 of Every Year

Name of Utility:   ____________________________________________________

Address & Zip:      ____________________________________________________

Telephone Number:                                                                 Fax:                      

Form Completed By:   ____________________________________________________

Title:            ____________________________________________________

Signature:                                                                       Date:                     

Name and Phone Number of Person/Department responsible for implementing a water conservation program:

 

UTILITY PROFILE

 

I.   POPULATION CUSTOMER DATA

   A.   Population and Service Area Data

      1.   Service area size (square miles):                                               

      2.   Current population of service area:                                             

      3.   Current population served by utility:

         a:   water      ________________

         b:   wastewater   ________________

4.   Population served by water utility service area for the previous five years:		5.   Projected population for in the following decades:
Year	Population	Year	Population
_______	____________	2010	____________
_______	____________	2020	____________
_______	____________	2030	____________
_______	____________	2040	____________
_______	____________	2050	____________
_______	____________	2060	____________

 

      5.   List specific source(s)/method(s) for the calculation of current and projected

         population:

   B.   Active Connections

      1.   Current number of active connections by user type. Check whether multifamily service is counted as Residential                 or Commercial                .

 

Treated water users	Metered	Not-metered	Total
Residential
Commercial
Industrial
Public
Other

 

      2.   List the net number of new connections per year for most recent three years:

 

Year	20XX	20XX	20XX
Total	______	______	______

 

   C.   High Volume Customers

      List annual water use for the ten highest volume customers (indicate if treated or raw water delivery). Provide date of most recent water use audit - if never audited, please indicate so.

	Customer	Use (1,000 gallons / year)	Treated / Raw Water	Date of Last Water Use Audit
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)

 

II.   WATER USE DATA FOR SERVICE AREA

   A.   Water Accounting Data

      1.   Amount of water use for previous five years (in 1,000 gal.):

Total Diverted and Treated Water Deliveries and Sales by Month
Month	Year
	20XX	20XX	20XX	20XX	20XX
January
February
March
April
May
June
July
August
September
October
November
December
Total

 

         Indicate how the above figures were determined (e.g., from a master meter located at the point of a diversion from the source or located at a point where raw water enters the treatment plant, or from water sales).

      2.   Indicate whether water is supplied from:

         a.   Untreated surface water sources:                      

         b.   Another utility as treated water:                      

      2a.   For entities that treat their own water:

         Does utility operate a raw water intake? If so, indicate intake location and minimum elevations of safe operation.

 

Location of raw water intake	Elevation

 

      2b.   For entities that purchase treated water from another utility, list water supply sources and quantity purchased from each source:

 

Treated water sources purchased	Quantity

 

      3.   Amount of water (in 1,000 gallons) delivered (sold) as recorded by the following account types for the past five years.

Account Type	Year
	20XX	20XX	20XX	20XX	20XX
Residential
Commercial
Public / Institutional
Industrial
Wholesale
Other
Total Sold
Residential:         Single + multifamily residences Commercial:         Restaurants, retail, office Public / Institutional:      Municipal, airports, schools, hospitals Industrial:         Large manufacturing Wholesale:         Deliveries to successive customers Other:            Uses not included in above categories.             Please describe:

 

      4.   Calculate gallons per capita per day by account types for the past five years.

Account Type	Gallons per capita per day by Account Type (Total water diverted (or treated) / population / 365)
	20XX	20XX	20XX	20XX	20XX
Residential
Commercial
Public / Institutional
Industrial
Wholesale
Other
Total

 

      5.   List previous five years records for water loss (the difference between water diverted (or treated) and water delivered (or sold)). The goal for percent of unaccounted for water is 12%.

 

Year	Amount (gal.)	% of Total Water Diverted or Treated
______	__________	_________
______	__________	_________
______	__________	_________
______	__________	_________
______	__________	_________

 

      6.   List previous five years records for water reuse. Reuse is the authorized use for one or more beneficial purposes of use of water that remains unconsumed after the water is used for the original purpose of use and before that water is either disposed of or discharged or otherwise allowed to flow into a watercourse, lake or other body of state-owned water.

 

Year	Amount (gal.)	% of Total Water Diverted or Treated
______	__________	_________
______	__________	_________
______	__________	_________
______	__________	_________
______	__________	_________

 

      7.   Municipal per capita water use (in gallons per day) for previous five years. Municipal per capita water use is the sum total of water diverted into a water supply system for residential, commercial, and public and institutional uses divided by total population served. GPCD includes water losses.

 

Year	Population	Total Water Diverted (or Treated) (1,000 gal.)	Municipal Per Capita Use (GPCD)
______	__________	_________	_________
______	__________	_________	_________
______	__________	_________	_________
______	__________	_________	_________
______	__________	_________	_________

 

      7.   Previously stated per capita goals:   5-year:                     10-year:    _________

                                 (by 200X)           (by 200X)

      8.   Did water use (GPCD) increase or decrease from previous year? _________

         Percent increase or decrease from previous year? ______________________

      9.   Briefly discuss reasons for the increase or decrease in municipal water use.

(Ord. OR-2631-24, passed 4-22-24)