HomeMy Public PortalAbout20100925_LEAK ADJUSTMENT REQUEST.docLEAK ADJUSTMENT REQUEST FORM
Account No.:
Name:
Service Address:
Daytime Phone:
A City of Tybee Island ordinance allows for a leak adjustment credit because of loss of water through an “excusable defect” in the customer’s water line. An excusable defect is due
to a rupture or leakage caused by weather, settlement, corrosion, wear, or accident. Visible leaks such as faucet, leaking toilet, irrigation system or hose leaks are ineligible.
No credit will be granted for sewer charges on swimming pools, spas, etc.
Credit may be given for one-half of the rate charged to usage in excess of the average. Credit may also be determined by using the data from Mosaic leak detection system, when available.
The adjustment is limited to a maximum of three (3) consecutive months and must be requested within six (6) months of the repair.
I, _______________________________________, am the Responsible Party for the account at the above service address. I am requesting the City of Tybee Island reduce the water bills for
this account, to the extent allowed by city ordinance because of a leak beginning on (date) ___________ and repaired on (date) ___________. The water lost from this leak was not used
by anyone.
IN ORDER TO PROCESS YOUR APPLICATION QUICKLY AND EFFICIENTLY,
PLEASE READ THE FOLLOWING AND GIVE A COMPLETE DESCRIPTION OF
THE REPAIRS.
Type of leak on customer’s side of meter: ___________________________________________________________
Description of repair: ___________________________________________________________________________ ____________________________________________________________________________________________________
______________________________________________________________________________________
Attach documentation of the repair date, address, type of repair, and cost. Acceptable documents include plumber’s statement/bill or a receipt for parts. Businesses with in-house maintenance
may submit a statement signed by two (2) employees who witnessed the repair.
In all cases the City retains the right to make field verifications before approving leak adjustments. You will be notified by mail or phone generally within 90 days whether your request
is approved or denied.
I am familiar with all of the facts stated in this document and they are true and correct. I certify that this application and attached documents contain no false statements.
Print Name:
Date:
Signature:
Complete the form and return to Utility Customer Service at City Hall, Tybee Island. Please call our Customer Service Center at 912 786-4573 x110 if you have any questions.
City Manager Approval:
Date:
Comments: