Private / Private 2 Party Water System Status Report

What to expect: When your application is submitted, you will be shown a receipt. You will also receive an email from noreply@skipthepaper.com. If you do not receive the email, please check your email program's spam filter and spam settings.

Required fields are indicated with red.

Applicant's Address
First Name:
Last Name:

Business Name:

Street 1:

Street 2:

City:
State:
Zip/Postal:


Email (will receive email updates):
Phone:
Water Service Property Address

Street 1:

Street 2:

City:
State:
Zip/Postal:


Tax Parcel #:
Question Section
QuestionAnswer
General
Is this evaluation for a 2 party well?
Is the home currently occupied?
Is the current property address the original property address?
Are there dogs or other constraints present, which would prevent access to the collection of the water samples by the Health District?
Has the water system been disinfected within the last 30 days?
Acknowledgments
A non frost-free hose bib is available on the outside of the home for taking the water sample.

Please note that taking water samples from frost-free hose bibs is not advisable.
Application Services
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Billing Address

First Name:
Last Name:

Business Name:

Street 1:

Street 2:

City:
State:
Zip/Postal:


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Terms and Conditions

By clicking on the Submit button below, you agree to the terms and conditions outlined above.



ORME Application v3.0