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Transmittal/Report Form for Private Water Systems Permits (one page report)

Transmittal and Report forms must be submitted quarterly for permits obtained within the quarter as required in Ohio Revised Code (ORC) 3709.092.

For permit fees collected from:

  • January 1 through March 31 must be submitted by no later than May 15
  • April 1 through June 30 must be submitted by no later than   August 15
  • July 1 through September 30 must be submitted by no later than   November 15
  • October 1 through December 31 must be submitted by no later than February 15

Transmittal and transmittal reports forms must be submitted for all new construction (including replacements, emergencies, conversions, test wells), alterations (emergency alterations), and sealing permits.  

Click the "Download" button to obtain the Private Water Systems Program Transmittal / Report Forms with one (1) report form.