Water survey

The purpose of this questionnaire is to help determine if your home or property may have any special plumbing or activities that may pose an increased risk of contamination to the water distribution system.

Please respond by entering your name and Bridgehaven address, and answering yes/no or checking the appropriate box below.

These questions relate to plumbing or activity present on customer's premises**

If you have checked “Yes” to any of the questions below, Bridgehaven staff will contact you to request further information. If you have any questions, please contact the Bridgehaven at (360) 739-0441.

**Based on their knowledge of residential connections served, public water systems may “customize” this list by adding or deleting plumbing categories or activities.

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Water Use Questionnaire for Residential Customers.

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Customer Name: *

Address: *

Underground sprinkler system *

Water treatment system (e.g., water softener) *

Solar heating system *

Residential fire sprinkler system *

Other water supply (whether or not connected to plumbing system) *

Sewage pumping facilities or grey water system *

Booster pump

Irrigation well

Photo lab or dark room

Hobby farm

Animal watering troughs

Swimming pool or spa

Home-based business. If Yes, please list type/describe (e.g., beauty salon, machine shop, etc.): *

Swimming pool or spa *

Greenhouse *

Decorative pond *

Boiler or radiant heating system with makeup water

Captcha (spam protection code) *

I herby agree that my data entered in the contact form will be stored electronically, and will be processed and used for the purpose of establishing contact. I am aware that I can revoke my consent at any time.

Note: Fields marked with * are required

DOT Hood Canal Bridge

WA State Dept of Fisheries

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