Instructions for Completing the Application for Water and Sewer Service

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Nicholas Harper
5 years ago
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1 Instructions for Completing the Application for Water and Sewer Service [A] - If Water Service is Already Available 1- Service Start Date-the first day you wish for the water service to be activated in your name. 2- Applicant (mailing address)-your name(s) as it is to read on the water bill and address where you would like to receive the water bill. If you wish that the application be in two names-both persons must provide the information in item #2 and sign the application. 3- SS#/FEIN (Social Security Number or Federal Employer Identification Number, if applicable)- please fill in. Services only activated Monday-Friday. There is no same day service, so be sure to mail or bring in your application in plenty of time (minimum 3 business days) before service start date in order that service is switched into your name on the desired day. If water is off at your location, then it will not be turned on until the next business day. If an application is received in our office after the service start date requested, it will be activated into your name on the following business day after it was received. No Service Start Date will be backdated. 4- Property Owner-the owner of the land on which the home or mobile home is setting. If you are the property owner as well as the applicant-write "SAME" and go to "Water Service Location". If you are renting be sure to provide ALL information for the property owner. 5- Water Service Location-give the 911 Street Address, Subdivision Name and Lot # of the property you are making application for. 6- Type of Service-check "residential" and provide the desired meter size (i.e. 5/8", 1", 2" etc). 7- Signature of Applicant-Applicant(s) must sign, date, and check one of the four boxes. 8- Notarize the application-all applications must be notarized if not signed in the presence of a BCPSWD Customer Service Representative. Please have the notary fill out the information and seal or stamp to the right of the paragraph. If you mail in the application and do not have it notarized, you will be required to bring the application into our office and sign it in front of office personnel before your service will be started. 9- Enclose the correct security deposit. See Security Deposit tables below to determine amount of security deposit to be paid. Make check payable to BCPSSD for the total amount. (Make check payable to BCPSSD even if you don't have Berkeley County sewer service.) All applications must be filled out in their entirety. If you have any questions regarding the application or need assistance filling out the application-please call the office between 8:00 a.m.-4:30 p.m. Monday-Friday at (304) When mailing or faxing an application please be sure of the following: It is completed in its entirety and signed by the applicant(s).

2 The application is notarized. A photocopy of the driver's license of the applicant(s) is included. Payment for the applicable security deposit (check or money order made payable to BCPSSD). If you plan to pay by credit card, (Mastercard, Visa or Discover), you must call and give the information to the office staff for processing. Mail or fax the application to: BCPSWD 251 Caperton Blvd. Martinsburg, WV Fax Number (304) Security Deposits County Water & Sewer: If you have both Berkeley County water service AND Berkeley County sewer service, then you must provide a combined security deposit that covers both water and sewer services. The table below shows the total deposit required for customers with County water and County sewer: Water + Sewer Total Meter Size Deposit 5/8-inch $ inch 1 ½-inch $ $ inch 3-inch $ $ inch 6-inch $ $ 1, inch $ 2, County Water only: If you have Berkeley County water service but DO NOT have Berkeley County sewer service, then you must provide a water security deposit. For example, if you have a septic tank or have sewer service from the City of Martinsburg, you need to provide only a security deposit for County water. The table below shows the deposit required for customers with County water but not County sewer: Meter Size Water Security Deposit 5/8-inch $ inch 1 ½-inch $ $ inch 3-inch $ $ inch 6-inch $ $ 1, inch $ 2, For owners only, the deposit plus interest will be applied to the customer's account after the customer has paid monthly bills on time for twelve (12) consecutive months. If owner moves prior to the security deposit being refunded, the security deposit plus interest will be credited to the final bill.

3 For tenants, deposits are not refundable after twelve (12) consecutive on time payments. Deposits with interest will be credited to the final bill at the time you move from the property. The simple interest rate is determined by the Public Service Commission of West Virginia.

4 APPLICATION FOR WATER AND SEWER SERVICE Berkeley County Public Service District 251 Caperton Boulevard Martinsburg, WV Phone: Fax: PLEASE PRINT ALL INFORMATION Service Start Date: Account Number APPLICANT: Mailing Address Street: City: State: Zip: SS#/FEIN: Place of Employment: CO-APPLICANT/ SPOUSE: SS#/FEIN: Place of Employment: PROPERTY/LOT OWNER: WATER AND SEWER SERVICE LOCATION: Street: City: State: Zip: Street: Subdivision: Lot #: Phase/Section: Type of Service: [ ] Residential [ ] Commercial Size [ ] Industrial Size Estimated Daily Demand Nature of Business: [ ] Private Fire Service Size Applicant(s) has read the conditions on the reverse of this form. By signing this application for water and sewer service, applicant(s) acknowledges and agrees to these conditions and that the information provided above is true and accurate to the best of applicant s knowledge. [ ] Owner [ ] Tenant [ ] Builder [ ] Applicant s Agent Signature of Applicant &/or Co-Applicant: ATTACH A COPY OF THE DRIVER S LICENSE(S) Date: For Use by Berkeley County Public Service District Received from Applicant/Co-Applicant: Water Previous Account#: Security Deposit $ Connection Charge $ Date to Final: WO#: Other (Specify) $ Comments: Sewer Security Deposit $ Total Received $ Thank you, Berkeley County Public Service District By: WA-1 (12/13) Date: NULL AND VOID AFTER 6 MONTHS White: District Copy Yellow: Applicant Copy

5 WATER AND SEWER SERVICE TERMS AND CONDITIONS As a customer you agree to abide by the following terms and conditions and all other restrictions. Required security deposits: For owners only, the deposit will be refunded with interest after customer has paid monthly bills on time for twelve (12) consecutive months. For tenants, deposits with interest will be credited to the final bill. The interest rate to be paid is determined by the Public Service Commission of West Virginia. The security deposits will be applied to any unpaid bill at the time of termination of service, with the balance of the said security deposit to be refunded to applicant. Service will be in accordance with the Rules and Regulations for the Government of Water Utilities (150CSR7) and the Rules and Regulations for the Government of Sewer Utilities (150CSR5). This application is for immediate and continuous service to premises described above and is accepted subject to the availability of service at this location. The applicant must request discontinuance of service during regular business hours and the District(s) have until the end of the next business day to discontinue water and sewer service. Until such time applicant is responsible for all services rendered. Changes to the above listed identity of the applicant, type or description of service will make this application and subsequent service(s) null and void. A new application will be required; however the customer shall be liable for any services rendered. The applicant has received a copy of the current tariff schedules and the applicant has been offered a copy of both sets of Rules and Regulations to read in the office. A septic tank customer must provide a copy of the septic tank permit or a letter from the sewer department stating that they are not on public sewer. The following pertain to water facilities: All domestic services shall be installed with an approved backflow prevention device. All private fire services shall be approved by the State Fire Marshal Office and be installed with an approved backflow prevention device. This application will not be approved until a substantial completion certificate has been issued for the water main to be tapped. All service facilities up to and including the water meter pit are now and forever will be the property of the Water District Any water service not in continuous use for a period greater than two years is considered abandoned and subject to physical removal by the Water District. The Water District has 24 hours from the receipt of a complete application to turn on water for an existing service; excluding weekends or holidays in which case the water will be turned on the next business day. The Water District has 10 days from date of verbal or written notification to install a water meter for a new service. The following pertains to sewer facilities: DO NOT dispose of CIGARETTE BUTTS, FEMININE HYGIENE PRODUCTS, DISPOSABLE DIAPERS, PAPER (other than toilet tissue), PLASTICS, COOKING GREASE, OR OTHER INAPPROPRIATE DEBRIS into the sanitary sewer system by way of your toilets, sinks or any other method. These items cause blocked sewer lines, pump station malfunctions and contribute to odor and treatment problems. These problems can cause health hazards and lead to expensive fixes. Disposing of inappropriate items into the sewer system ultimately results in an increase in your bills. If you are in doubt about what is acceptable, please contact the Sewer District at for a copy of a Household Plumbing Guide and a Hazardous Waste Disposal Guide. The applicant agrees to refrain from discharging water from the following sources into the sewer system: sump pumps, roof down spouts, indoor floor drains, cooling waters from air conditioners, swimming pools, storm drains and groundwater sources. Cleanouts are to remain tightly capped to prevent surface water from entering the sanitary sewers. WA-1 (3/11)

Public Health - Dayton & Montgomery County

Public Health - Dayton & Montgomery County Reibold Building, 117 South Main Street, Dayton, OH 45422-1280 (937) 225-5700 www.phdmc.org TO: FROM: All Plumbing Contractors Jeffrey A. Cooper, M.S., Health