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.