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Adequacy
331-291 -
Water System Adequacy Request Form - Southwest Regional
Office (PDF)
331-292 - Water
System Adequacy Request Form - Northwest Regional Office
(PDF)
331-293 - Water System
Adequacy Request Form - Eastern Regional Office (PDF)
331-321 - Adequacy Request Form - Lending Institutions and
Realtors (Word)
331-321
- Adequacy Request Form - Lending Institutions and Realtors (PDF)
Consumer Confidence Report
331-203
Consumer Confidence Report Certification Form (Word)
331-203 Consumer Confidence
Report Certification Form (PDF)
Contract Operators
New: 331-439
Contract Operator Public Listing Form (Word)
New:
331-439 Contract Operator Public Listing
Form (PDF)
Cross Connection
331-243 -
Cross-Connection Control Program Backflow Incident Report
Drinking Water
State Revolving Fund 2008
331-201 2009 Drinking Water State
Revolving Fund Application Form (PDF)
Engineering and Planning Submittals
331-121 -
Construction Completion Report (Word)
331-121 - Construction Completion
Report (PDF)
331-122
- Engineering Design Review Report (For Distribution-Related Project
Submittal Exceptions) (Word)
331-122 - Engineering Design Review Report (For
Distribution-Related Project Submittal Exceptions) (PDF)
331-146 -
Construction Completion Report Form for Submittal Exception Process
(Word)
331-146 - Construction
Completion Report Form for Submittal Exception Process
(PDF)
331-147 -
Construction Completion Report Form for Distribution Main Projects
(Word)
331-147 - Construction
Completion Report Form for Distribution Main Projects (PDF)
331-149 -
WA State Dept. of Health, Project Approval Application (Word)
331-149 - WA State Dept. of Health,
Project Approval Application (PDF)
331-396 -
Small Water System Management Program Submittal (Word)
331-397 - Water System Plan Submittal (Word)
Water
Rights
Self Assessment
Instructions for
Completing the Water Rights Self Assessment Forms
(Word)
331-370 - Project Report
Form - Water Rights Self Assessment (Word)
331-370 - Project Report Form - Water Rights Self Assessment
(PDF)
331-371 - Water System Plan - Water Rights Self Assessment -
Existing Status (Word)
331-371 - Water System
Plan - Water Rights Self Assessment - Existing Status (PDF)
331-372 - Water System Plan - Water Rights Self
Assessment--6 Year Forecast (Word)
331-372 - Water System
Plan - Water Rights Self Assessment--6 Year Forecast (PDF)
331-373
- Water System Plan - Water Rights Self Assessment--20 Year
Forecast (Word)
331-373 - Water System
Plan - Water Rights Self Assessment--20 Year Forecast (PDF)
Groundwater Under the Influence of Surface Water
331-189 - Potential GWI Source Identification and
Designation(PDF)
331-190
- GWI Determination Process Purveyor's Choice (PDF)
331-191 - GWI Quality
Monitoring Interview Documentation (PDF)
331-192 - GWI Water Quality
Monitoring Confirmation (PDF)
331-193 - GWI Water Quality
Monitoring Report Form (PDF)
331-194 - GWI Hydraulic
Connectivity Determination, Analysis of Water Quality Monitoring
Date (PDF)
331-195 - GWI
Hydraulic Connectivity Determination, Descriptive Statistics (PDF)
Public Notification
331-163 - Coliform Major Monitoring
Violation Public Notice (PDF)
331-248 - Public Notice Certification Form Nitrate MCL
Violation
(PDF)
331-263 - Coliform Maximum Contaminant Level Exceeded:
Non-Acute MCL (PDF)
331-264 - Public Notice Certification Acute Coliform MCL (PDF)
331-347
- Lead and Copper Monitoring Violation - English and Spanish
(Word)
331-354 - Lead and Copper
Initial Monitoring Violation
(PDF)
331-357 -
Notice to Water System Users: Annual Nitrate Monitoring
Violation (Word)
331-357 - Notice to Water System Users: Annual Nitrate
Monitoring Violation (PDF)
331-360 - Disinfection Byproducts Monitoring Violation (PDF)
331-360 - Disinfection
Byproducts Monitoring Violation (Word)
331-360 Spanish - Disinfection Byproducts Monitoring Violation (PDF)
331-360 Spanish - Disinfection
Byproducts Monitoring Violation (Word)
331-394 - Monthly Bromate Monitoring Violation (PDF)
331-394 - Monthly Bromate
Monitoring Violation (Word)
331-395 - Quarterly Total Trihalomethane (TTHM)/Haloacetic
Acids (HAA5) Monitoring Violation (PDF)
331-395 - Quarterly Total
Trihalomethane (TTHM)/Haloacetic Acids (HAA5) Monitoring
Violation (Word)
331-412 -
Quarterly Nitrate Monitoring
Violation Form (PDF)
331-412 - Quarterly Nitrate
Monitoring Violation Form (Word)
331-416 - Notice to Water System Users:
Reliably and Consistently Under the Maximum Contaminant Level -
Annual Nitrate Monitoring Violation Form (PDF)
331-416 - Notice to Water System Users: Reliably and Consistently
Under the Maximum Contaminant Level - Annual Nitrate Monitoring
Violation Form (Word)
Surface Water Treatment
Forms - You will need Microsoft Excel 97 or a later
version on your computer to use these forms.
#331-023 - Water Treatment Plant
Monthly Report Summary
#331-048 - SWTR Disinfection
Monthly Report
#331-172 - Surface Water Treatment
Plant Monthly Report Summary
Excel file includes CT look up
table.
The three forms above (#331-023, #331-048
& #331-172) are contained in one Excel workbook file. After opening
the file, note the four tabs at the bottom. The first tab (Cover
Page and Notes) contains the directions on use of the forms. Open
and read it first. Then click on the other tabs to access the
forms.
Open the Excel Workbook
(507 KB) and view the directions (Cover Page and Notes) and
forms above.
Water Quality
Coliform
331-319
- Coliform Bacteria Analysis Form Templates
E. coli - Fecal
Coliform Community Drinking Water Warning notice (Word)
E. coli - Fecal
Coliform Community Drinking Water Warning notice (PDF)
E. coli - Fecal
Coliform Non-community Drinking Water Warning notice (Word)
E. coli - Fecal
Coliform Non-community Drinking Water Warning notice (PDF)
Disinfection Byproducts
331-341
- Disinfection Byproduct Monitoring Plan (Excel 119 KB). The
two organizations below can provide assistance with completing
this form.
Evergreen Rural Water of Washington (ERWOW)
Rural Community Assistance
Corporation (RCAC)
Epichlorohydrin and
Acrylamide
331-337
- Certification Form of Epichlorohydrin and Acrylamide Usage
(Word)
331-337 - Certification
Form of Epichlorohydrin and Acrylamide Usage
(PDF)
Water Use
Efficiency
#331-376 - Annual Water
Use Efficiency Performance Report
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