CITY OF HONEY GROVE WATERWORKS

APPLICATION FOR SERVICE

OCCUPANT’S NAME ____________________________________________ 

RESPONSIBLE PARTY     ___________________________________________________

 (If Different from Occupant) 

SERVICE ADDRESS          _________________________________________________

MAILING ADDRESS         _________________________________________________

 (If Different from Service Address)

HOME PHONE:  ____________________     WORK # / ALTERNATE # _______________

BUSINESS PHONE: _______________________

DL#   _______________________                 SSN # ______________________               

NUMBER LIVING IN HOUSE   ______

                OWNER ______________________________________

NAME OF BUSINESS__________________________________________

(If different than above name)

 (If this is a Commercial Account)

TYPE OF BUSINESS ____________________________________________________

A $100.00 DEPOSIT IS REQUIRED FOR RESIDENTIAL WATER SERVICE OR $200.00 FOR A BUSINESS DEPOSIT. THIS AMOUNT MUST BE PAID IN FULL AND APPLICATION COMPLETED AND SIGNED WITH PICTURE ID BEFORE SERVICE IS ACTIVATED.  DEPOSITS WILL REMAIN WITH THE CITY UNTIL SERVICE IS DISCONTINUED / TERMINATED DUE TO MOVING OR NONPAYMENT.  DEPOSITS WILL NOT BE REFUNDED UNTIL ANY BALANCES OR FINAL BILLS ARE PAIDIN FULL.  THE DEPOSIT MAY BE APPLIED TO ANY BALANCES DUE.

A NON-REFUNDABLE WATER &/OR SEWER TAP FEE OF $300.00 EACH WILL BE REQUIRED FOR ANY NEW HOMES OR A BUSINESS WHERE SERVICES ARE NOT PRESENT ON PROPERTY.  ANY REQUEST FOR SERVICES OUTSIDE THE CITY LIMITS MUST BE PRESENTED TO THE CITY COUNCIL IN WRITING AND UPON APPROVAL WILL REQUIRE A $750.00 TAP FEE PER SERVICE AND WATER DEPOSIT OF $100.00.  THE CUSTOMER WILL BE RESPONSIBLE FOR ALL LINES AND CONNECTIONS ACROSS THEIR PROPERTY TO CONNECT TO OUR METER/ SERVICES.

WATER BILL PAYMENTS ARE DUE ON THE 10^TH OF EACH MONTH.  IF THE 10TH FALLS ON A WEEKEND OR HOLIDAY, DEADLINE IS EXTENDED TO THE FOLLOWING MONDAY OR WORK DAY.  A $10.00 LATE FEE IS ADDED AT THIS TIME.  THERE IS A NIGHT DROP AVAILABLE 24 HOURS A DAY LOCATED ON THE SOUTH SIDE OF CITY HALL.

FINAL DAY TO PAY BILLS IS THE 20^TH OF EVERY MONTH. A PENALTY/RECONNECT/EXTENSION FEE OF $40.00 IS AUTOMATICALLY ADDED TO BILL AT 8:00 AM ON THE 21^ST OF EACH MONTH.  WATER SERVICE TERMINATIONS WILL START AT 8:00AM ON THE 21^ST OF EACH MONTH.  YOU MUST CALL ON OR BEFORE THE 20TH IF YOU NEED AN EXTENSION BEYOND THE 20^TH.  YOU WILL STILL BE CHARGED THE $40 AND THE EXTRA EXTENSION WILL NOT GO BEYOND THE LAST DAY OF THE MONTH.

ACTIVATION OR RECONNECTS WILL NOT BE DONE AFTER 4:00 PM

   You are not required to furnish the following information, but are encouraged to do so. The following is requested by the Federal Government in order to monitor compliance with Federal Laws prohibiting discrimination against applicants seeking to participate in this program. Information will not be used in evaluation of your application.  We are required to make a note of race/national origin based on visual observation or surname if you do no wish to furnish this information.

Caucasian ______   African American ______  Hispanic/Latino _____  Asian _____   other __

Male ___________         Female  ___________

SERVICE AGREEMENT

290.47(b) Appendix B.

SERVICE AGREEMENT

 I.         PURPOSE.  The CITY OF HONEY GROVE WATER SYSTEM is responsible for protecting the drinking water supply from contamination or pollution, which could result from improper private water distribution system construction or configuration.  The purpose of this service agreement is to notify each customer of the restrictions, which are in place to provide this protection.  The utility enforces these restrictions to ensure the public health and welfare.  Each customer must sign this agreement before the HONEY GROVE WATER SYSTEM will begin service.  In addition, when service to an existing connection has been suspended or terminated, the water system will not re-establish service unless it has a signed copy of this agreement.

II.         RESTRICTIONS. The following unacceptable practices are prohibited by State regulations.

            A.     No direct connection between the public drinking water supply and a potential source of contamination is permitted.
                    Potential sources of contamination shall be isolated from the public water system by an air-gap or an appropriate backflow prevention device.

 
            B.     No cross-connection between the public drinking water supply and a private water system is permitted.  These potential threats to the public drinking water supply shall be eliminated at the service connection by the installation of an air-gap or a reduced pressure-zone backflow prevention device.

           C.     No connection, which allows water to be returned to the public drinking water supply, is permitted.

           D.     No pipe or pipe fitting which contains more than 8.0% lead may be used for the installation or repair of plumbing at any connection which provides water for human use.

           E.     No solder or flux which contains more than 0,2% lead can be used for the installation or repair of plumbing at any connection which provides water for human use.

III.       SERVICE AGREEMENT.  The following are the terms of the service agreement between the CITY OF HONEY GROVE WATER SYSTEM and _____________________________________________. (Customer Name)

          A.     The Water System will maintain a copy of this agreement as long as the Customer and/or premises is connected to the Water System.

          B.     The Customer and/or Owner shall allow his property to be inspected for possible cross-connections and other potential contamination hazards. These inspections shall be conducted by the Water System or its designated agent prior to initiating  new water service; when there is reason to believe that cross-connection or other potential contamination hazards exist; or after any major changes to the private water distribution facilities.  The inspections shall be conducted during the Water System’s normal business hours.

          C.     The Water System shall notify the Customer and/or Owner in writing of any cross-connection or other potential contamination hazard, which has been identified during the initial inspection or the periodic re-inspection.

          D.     The Customer and/or Owner shall immediately remove or adequately isolate any potential cross-connections or other potential  contamination hazards on his premises.

          E.     The Customer and/or Owner shall, at their expense, properly install, test, and maintain any backflow prevention device required by the Water System.  CITY OF HONEY GROVE WATER WORKS requires yearly testing by an approved and licensed inspector with original to be kept on file at the Water System’s office.  Copies of all testing and maintenance records shall be provided to the Water System.

IV.      ENFORCEMENT.  If the Customer and/or Owner fails to comply with the terms of the Service Agreement, the Water System shall, at its option, either terminate service or properly install, test, and maintain an appropriate backflow prevention device at the service connection. Any expenses associated with the enforcement of this agreement shall be billed to the Customer and/or Owner. 

           THE CITY OF HONEY GROVE WATER SYSTEM requires that all Water Customers/ Owners  have or install, at their expense, a cutoff on their side of the meter. This will be used to turn water service off and on for any repairs or plumbing work.  You may not  use the Water System’s cutoff to turn your service on/off for any reason.  Anyone using the Water System’s cut off at the meter may be subject up to a $500 fine.

______________________________________                       _____________________

Signature Customer / Owner                                                                 Date