Moses Lake, WA · Grant County
Water Service Hazard Evaluation Questionnaire
The questionnaire helps the Moses Lake Water Division evaluate potential water service hazards at a property served by its water system.
What this form is
Property owners or other people completing the questionnaire identify whether listed facilities or conditions are present at the property served by the water service. The form requests a building permit number, account number, service address, owner name, phone, date, facility responses, and the name, signature, and date of the person completing it. Return it within 30 days.
Who needs it
People completing a water service hazard evaluation for a property served by the Moses Lake water system should submit this questionnaire.
How to submit it
Return the questionnaire within 30 days to Judi Ellis, Water Quality Specialist, City of Moses Lake Water Division, PO Box 1579, Moses Lake, WA 98837, or fax it to (509) 766-3615.
About notarization
This document is signed without a notary; the person completing it just signs and dates the questionnaire.
How to submit this form
- 1
Download The Questionnaire
Download the Water Service Hazard Evaluation Questionnaire.
- 2
Complete The Form
Enter the building permit and account numbers, service address, owner name, phone, and date; mark YES or NO for each listed facility or condition.
- 3
Sign And Date
Print the name of the person completing the questionnaire, then sign and date it.
- 4
Return It To The Water Division
Return the questionnaire within 30 days by mail to the listed address or fax it to (509) 766-3615.
Frequently asked questions
- What is the Water Service Hazard Evaluation Questionnaire?
- It asks whether listed facilities or conditions are located on the property served by a water service and collects property, account, and completion details.
- Who should complete this questionnaire?
- A person completing the water service hazard evaluation should provide the requested property and account information, mark the applicable facility responses, and sign and date the form.
- How do I submit the questionnaire?
- Return it within 30 days to Judi Ellis, Water Quality Specialist, City of Moses Lake Water Division, PO Box 1579, Moses Lake, WA 98837, or fax it to (509) 766-3615.
- Do I need a notary for the questionnaire?
- No. This document is signed without a notary; the person completing it just signs and dates the questionnaire.
Need something notarized?
This Water Service Hazard Evaluation Questionnaire doesn’t need a notary — but if you have another Moses Lake form that does, a commissioned online notary can help.