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Annual Information Request Form

Water System Client,

In accordance with the SD DANR, we routinely need information to complete / mail / email reports and fulfill regulatory obligations. The information collected is held in confidence and only used for the water system’s record keeping and water report mailings.

The SD DANR approves EMAILING of annual Drinking Water Reports and Public Notices for public water systems which saves publication / postage costs for the water system. For this to work, each water system must have / maintain an up-to-date email list. Sage Water Works, Inc. will prepare the report and coordinate with the board for delivery. If emailing is not an option for your system, we will continue to mail reports.

Please provide a current mailing list for each home or business using / connected to the water system. This is required by the SD DANR to notify residents of water quality issues. If Sage Water Works, Inc. provides water billing services for your community, I already have the addresses and emails.

Annual Information Request Form

Water System Information

MM slash DD slash YYYY
Person or business completing the form(Required)
Interested in having SD DANR Drinking Water Reports emailed?
Public water systems only
Required by DANR
If billing is handled by your HOA/Water System, please upload a current mailing list for each home or business using or connected to the water system. If easier, the mailing list & form may be emailed to
Max. file size: 128 MB.

Board Member Information

Please list all board members/billers, titles, phone numbers, and preferred email address
Board member 1
Board member 2
Board member 3
Board member 4
Board member 5

*Form can also be printed and mailed to:

Sage Water Works
C/O 5310 Ebony Place
Piedmont, SD 57769