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APPLICATIONS AND FORMS

 

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General

Customer Service


Applications/Forms and Services

Read Your Water Bill

Automatic Bill Payment

 


The following table displays a description of applications and forms used by the Department.  It will also include requests for Professional Services, Bid Invitations, Govt Record Request, and Job Openings.  The forms are only available in Adobe Acrobat format, and requires Acrobat Reader 5.0 or greater.  Follow the link below to download the latest copy of the Acrobat Reader.  Most of the Engineering Forms/Applications below are now interactive.  You can fill the forms out on-line, print them out and then mail/fax/hand deliver them to the department.

 

 If you have any questions regarding the forms, please call the corresponding number below.



This file format requires the free Acrobat Reader from Adobe.



Professional Services, Bid Invitations, Government Record Request and Job Applications
Form Name Form Description  

Request Record

Request to Access A Government Record (DOW Fee Schedule)  
Various Forms
Form Name Form Description Last Updated

Notary Jurats

Sample Notary Sections (jurats) for your notary public to use with your Department of Water (DOW) documents.   If applicable, please select the notary section to fit your situation and attach with your other DOW documents.  (Revise if necessary to match your situation.)  October 2020

Conveyance of Water Facility

Conveying Private Facility to the Department of Water September 2009

Conveyance of Water Facility-DSL

Conveying a Double Service Lateral with Two Tax Map Key numbers for a Private Facility to the Department of Water September 2009
Elevation Agreement

An ageement stating that the property is at an elevation that the Department of Water cannot be assured of a dependable water supply or of adequate service

September 2013
Elevation Agreement for Condominiums For condominium owners. An ageement stating that the property is at an elevation that the Department of Water cannot be assured of a dependable water supply or of adequate service September 2013
Grant of Easement An agreement to grant, bargain, sell and convey to the Department of Water an easement in perpetuity September 2009
Right of Entry Temporary Entry to Land September 2009
Waiver & Release An agreement stating that no County supplied water service of any kind exists and acknowledging and accepting the fact that no County supplied water service may ever exist at the location. September 2013
Waiver and Release for individual CPR Waiver and Release Agreement for an Individual CPR Unit September 2013
Waiver of Construction Drawings Agreement to approve water meter service for property, without the requirement of a construction drawing of the water meter connections as required under the Rules and Regulations of the Department of Water September 2013
Non-Development Agreement Agreement to subdivide property but knowing that the property's existing water system facilities are inadequate to provide additional water service September 2009
Cost Breakdown Final cost breakdown of the water facility that is being conveyed by the owner to the Department of Water January 2002
Non-Interconnection Agreement No interconnections between water supplied by DOW's water meter and water supplied by the private water system exist or shall be constructed.  May 2010
Leak Adjustment Form Adjustment Request for Undetected Underground Leaks 
New Service Lateral Request for new water meter service connection (new service lateral)
BFP Test Form Backflow Prevention Test Form
BFP Testers APPROVED LIST OF CERTIFIED BACKFLOW PREVENTION ASSEMBLY TESTERS - March 2020 - List Subject to Change
Various Applications
Apply for Water Service Application for Water Services (Existing Water Meter Box)
Transfer of Service Account Transfer the service account to a new owner/renter
Application for Temporary Water Service Appliction for Temporary Fire Hydrant Use
New/Renewal Agricultural Application Application and Renewal Form for Agricultural Rates
Payment Plan Application Application for Promissory Note
  Automatic Bill Payment (ABP) Form The Kauai Department of Water invites you to select an easy way to pay your water bill with our new Automatic Bill Payment (ABP) service.  Your participating bank, savings and loan, or credit union can pay your water bill by deducting the amount due automatically from your financial account.  Save on writing checks, stamps, and envelopes 

 

 

 

 

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