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HomeMy Public PortalAboutApplication for Relay/Relocation, Cut/Capapplication for relay and cut and cap 7-1-19.doc Application Fee: $50.00 Cut & Cap: $200.00 Internal Use Only: Initial: _____ Check #:_____ TOWN OF BREWSTER WATER DEPARTMENT APPLICATION for RELAY / RELOCATION And Cut & Cap of EXISTING WATER SERVICE TODAYS DATE: ___________ ACCOUNT # _________ MAP/LOT________/_______ BREWSTER PROPERTY: OWNER: OWNER’S MAILING ADDRESS: OWNER’S PHONE NUMBER: BUILDER: BUILDER’S PHONE NUMBER: EMAIL: _____ CUT and CAP: __________ PROPOSED WORK: ________________________________________ WATER INSTALLER: ______________________DATE OF WORK: I/We agree by virtue of submitting this application that the water meter, pipeline and all fixtures and fittings used in said installation from the main to the meter inclusive shall be the property of the Town of Brewster, and that an easement is hereby granted for maintenance and repair of same. A certified septic plan signed and dated by the Brewster Health Department showing septic and water line must be approved by the Brewster Water Department and must accompany this application. If there is no Certified Septic Plan on file with the Board of Health, additional information will be required on a case by case basis. Any requested changes from the Certified Plan will be discussed with the office and noted on the Certified Plan. Final decision of the water service location shall be mutually agreed upon between the owner and the Superintendent of the Water Department. Either the Brewster Water Department or an approved Water Installation Contractor must be contracted by the homeowner or agent thereof for all water works within the town of Brewster. In case of a multiple use meter, a sketch indicating where the meter is to be installed must accompany this application. I/We agree that the Brewster Water Department or its agents are not liable for damage to property or utilities, above or below ground, unless accurately specified or indicated on the service sketch. The Brewster Water Department employees and contractors shall use care to minimize damage to lawn, shrubs, trees and other property. The equipment to be used for the installation shall be at the discretion of the Brewster Water department. I/We agree to, at my/our option, remove and replace sod, loam topsoil, shrubs, trees and driveway at my/our expense. It is understood that, in The Town of Brewster, when the relay or relocation of an existing water service is required due to rebuilding/reconstructing, making alterations, constructing additions and/or demolitions to a home/property, a Permit is required along with the associated fee and is expected to accompany this form. Checks are payable to The Brewster Water Department. This application and accompanying fee are required in order to receive a permit to cut and cap the existing water service and relay or relocate a new water service to the above referenced property. _________________________________________________________________ OWNER’S or ACTING AGENT’S SIGNATURE DATE Permission to disrupt the existing water service line is not granted without signature of the PERMIT FOR RELAY/RECONSRUCTION OF EXISTING WATER SERVICE. DEMOLITION OF PROPERTY may not begin until water service has been cut & capped as per permit specifications.