Fillable 1662 Fire Hydrant Use Information (City of High Point)

Fill Online, Printable, Fillable, Blank 1662 Fire Hydrant Use Information (City of High Point) Form

Use Fill to complete blank online CITY OF HIGH POINT (NC) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

1662 Fire Hydrant Use Information (City of High Point)

On average this form takes 11 minutes to complete

The 1662 Fire Hydrant Use Information (City of High Point) form is 3 pages long and contains:

  • 0 signatures
  • 15 check-boxes
  • 37 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of High Point

BROWSE CITY OF HIGH POINT (NC) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
12.3.2012
Fire Hydrant Information
Fees For Fire Hydrant Meter
Application For Fire Hydrant Meter
Designated Hydrant Locations
Fire Hydrant Use Policy
Public Services Department
City of High Point, North Carolina
Public Services Department
FEES FOR FIRE HYDRANT METER ASSEMBLY
City of High Point, NC Fees for Fire Hydrant Meter Assembly 12.3.2012
Schedule of Fees for a Water and Sewer Account using a Hydrant Meter Assembly
Application Fee to Open a New Account
$50
Deposit for Meter Assembly
Hydrant Meter Assembly with a 5/8” meter and 3/4” backflow preventer $200
Hydrant Meter Assembly with a 3” meter and 3” backflow preventer $800
Note: Deposits represent security for the return of the Hydrant Meter Assembly in good condition at the
time the Account is closed. Deposits are held by the City without the accrual of interest as long as the
Account is open.
Monthly Fixed and Commodity Charges
As currently defined in the Water Rate Schedule and Sewer Rate Schedule.
City of High Point, North Carolina
Public Services Department
APPLICATION FOR FIRE HYDRANT METER
City of High Point, NC Application for Fire Hydrant Meter Page 1 of 2
Name:
Size of Hydrant Meter Assembly Requested
Type of Business:
5/8” Meter with 3/4” Connection:
Delivers up to 10 gallons per minute.
Billing Address:
City/State/Zip:
3” Meter with 3” Connection:
Delivers up to 175 gallons per minute.
Phone #:
Estimate period of time use of fire hydrant requested:
Check box if proposed use is continuous for an unspecified length of time.
Estimated volume of water required per month: gallons. (Total estimated volume if use is less than one month)
SPECIFIC PURPOSE FOR WATER FROM FIRE HYDRANT
Specific Property or Site, Please Provide Address:
Variable Locations Transported by Vehicle:
Address:
Make/Model/Year:
If No Address is Assigned, Please Provide:
License Tag#:
Tank Size:
County Tax ID#:
Subdivision:
Make/Model/Year:
Nearest Street Intersection:
License Tag#:
Tank Size:
Additional Information:
My signature below confirms that I have read the City of High Point Fire Hydrant Use Policy and the requirements
on the reverse side of this application form, and agree to comply fully with all specified terms. The information
provided on this application fully represents my intended use of this service.
Initials Acknowledging
Receipt of Hydrant Meter Assembly Signature of Applicant Title Date
-------- INFORMATION BELOW TO BE COMPLETED BY THE CITY OF HIGH POINT - -------
Fees Received: $
Account #:
Deposit Received: $
Metered Water use to be billed for Sanitary Sewer
Check : #
Credit Card
Hydrant Meter Assembly Issued: inches
City Credit Check Completed Meter Serial Number:
Privilege License – License number:
NOT Approved – reason:
Designated hydrant # and location:
Application Approved by: Date Approved:
Other conditions of approval:
Phone #:
City of High Point Privilege License #:
City of High Point, North Carolina
Public Services Department
APPLICATION FOR FIRE HYDRANT METER
City of High Point, NC Application for Fire Hydrant Meter Page 2 of 2
Customer Requirements and Conditions for Withdrawing Water Using a Hydrant Meter Assembly
The Customer agrees to the following conditions:
Use of water withdrawn from fire hydrants will be used only for the specific purposes stated on this application and only at the
locations described on this application.
If water is transported in a tank mounted to a vehicle, only the vehicles specifically named in this application will be used. On public
highways, applicable laws and regulations will be followed at all times.
The following instructions will be followed at all times when using an authorized fire hydrant:
o Remove one of the two smaller caps from the hydrant slowly, turning in a counterclockwise direction.
o Lay hydrant meter assembly on the ground flat, next to hydrant; avoid dirt or other material getting inside assembly piping or equipment.
o Connect one end of fire hose to hydrant threads where cap was removed, and other end of hose to the front end of the hydrant meter
assembly.
o Attach hose or pipe to the back end of the Assembly and connect the other end to the tanker truck or to the pipe that will convey water to
the point of use.
o Check to make sure the hand valve on the hydrant meter assembly is closed.
o Use only a City-furnished hydrant wrench on the five-sided operating nut on top of the hydrant. Slowly open fire hydrant by two
counterclockwise revolutions of wrench (not faster than one revolution per five seconds). Check all hoses and assembly for leaks.
o Continue to open hydrant by turning wrench slowly until the hydrant valve is fully open. DO NOT STAND DIRECTLY IN FRONT OF WHERE
HOSE IS CONNECTED TO HYDRANT.
o Open the hand valve on the hydrant meter assembly to control the rate of water flow to the tanker truck or end use. Throttle the flow using
the hand valve and turn the hand valve off when water is not in use. DO NOT USE THE HYDRANT VALVE TO THROTTLE OR CONTROL FLOW.
Leave the hydrant valve completely open until ready to disassemble the hydrant meter assembly from the fire hydrant.
o To begin disassembly of the hydrant meter assembly from the fire hydrant, close the hand valve on the assembly.
o Close hydrant valve using the City-furnished hydrant wrench. Turn wrench slowly clockwise (not faster than one revolution for every five
seconds) until wrench will no longer turn.
o Open hand valve on back end of assembly to relieve any pressure inside assembly.
o Disconnect the hose from the fire hydrant and place the cap back on the fire hydrant.
Only the specific fire hydrants identified on this application will be used. The Hydrant Meter Assembly will not be used for any purpose
other than the conveyance of water from these fire hydrants.
The Hydrant Meter Assembly will not be disassembled, disconnected, repaired, or tampered with in any way at any time. If a leak or
failure of operation occurs, or if the water meter stops operating, the entire Assembly will be promptly returned to the City
All provisions of the City of High Point Fire Hydrant Use Policy will be followed at all times.
The Hydrant Meter Assembly will be used at all times when withdrawing water from City fire hydrants. The meter reading on the
Assembly will be called in to the City of High Point Customer Services Department by the end of the last business day of each month
while the account approved by this application is active, whether or not water has been used during the month.
The Customer is financially responsible to the City for all metered water registered on the Hydrant Meter Assembly as long as the
Assembly is issued to the Customer. The Customer is responsible for protection against all unauthorized use of the Assembly.
The monthly bill issued by the City for this account will be paid on or before the due date, and any penalties or interest due will be
paid for any late payment. Monthly billing, to include the minimum fixed water charge, will be due each month this account is active,
whether or not water is used. City sanitary sewer commodity charges will apply to all metered water use on the Hydrant Meter
Assembly unless noted otherwise on the reverse side of this application by City personnel. If noted otherwise, the exemption from
sanitary sewer commodity charges remains effective only as long as water use is consistent with the purpose represented in this
application.
The City will be permitted to inspect the Hydrant Meter Assembly at any time a reasonable request is made.
During periods of time of drought when water use for specified purposes may be restricted by the City of High Point under water
conservation declarations, this account will not be used for purposes restricted by water conservation requirements.
The Hydrant Meter Assembly will be returned to the City at the time this account is closed. If this account remains open longer than a
year, the Assembly will be returned to the City not later than one year from the date of Application Approval shown on the reverse
side of this application. A new Assembly will be issued if this account remains open during the succeeding year.
The withdrawal of water from fire hydrants will cease immediately if notice is received from the City that this account has been
terminated or closed, and the Assembly will be returned to the City within five business days of receipt of such notice.
The Deposit paid as part of this application will be retained by the City until all Assemblies issued under this account have been
returned to the City and this account is closed. Any final amounts owed under this account may be retained from the Deposit at the
time the account is closed, to include the cost or repair or replacement of the Assembly if the Assembly is damaged or lost.
The Customer Responsibilities defined in the City of High Point Customer Services Policy will be adhered to at all times.
City of High Point, North Carolina
Public Services Department
DESIGNATED HYDRANT LOCATIONS
City of High Point, NC Designated Hydrant Locations 12.3.2012
NORTHWEST
500-BLK James Road # 1052
3038 Ingleside Drive # 4919
Johnson Street @ Immaculate Heart Church # 4564
NORTHEAST
Sedgebrook St reet # 2718
4135 Mendenhall Oaks Pkwy # 2862
Morris Farm Drive # 2522
5301 Samet Drive # 2734
Barrow Road @ Fair Oaks Lane # 1540
SOUTHEAST
2410 Williams Ave # 3547
Dillon Road @ Kivett Drive # 5791
Swathmore Ave @ Archdale Rd # 3997
Wise Ave @ Pershing Street # 2074
At the corner of Orville Drive @ Manor Drive # 3660
SOUTHWEST
801 Leonard Ave # 225
Kensington Drive @ Robin Hood Road # 2266
2611 Uwharrie Road # 4082
800-BLK South Road @ Moreland Ave No Tag
City of High Point, North Carolina
Public Services Department
FIRE HYDRANT USE POLICY
City of High Point, NC Fire Hydrant Use Policy Page 1 of 6
1.0 Purpose of Fire Hydrants
It is the policy of the City of High Point, North Carolina that the opening or closing, damaging,
tampering, connection to, or withdrawal of water from any publicly owned or privately owned fire
hydrant connected to the City of High Point water system is expressly prohibited, except in
compliance with the terms of this Policy. Authorized withdrawal of water from any fire hydrant
defined above is strictly limited to the following persons and purposes:
1.1. Fire fighting activities by personnel of the City of High Point Fire Department and by personnel
of other fire departments registered with the Director of Public Services (Director). Fire
departments that provide fire protection services within a jurisdiction served by City fire
hydrants, or fire departments that provide mutual aid within any area served by City fire
hydrants, may register with the Director.
1.2. Fire fighting training activities by the City Fire Department or by other fire departments
registered with the Director.
1.3. Test operations to establish the rate of the flow of water available from fire hydrants by
personnel of the City Fire Department, a registered Fire Department, or authorized personnel
of the City Public Services Department. These test operations may include the testing
necessary to furnish data needed for fire insurance evaluations or engineering evaluations of
the effectiveness of the water system.
1.4. Water flushing and collecting of water samples by authorized City Public Services Department
personnel for improving or determining the quality of water in the City water system, or to
minimize the possibility of impurities remaining in the water system from breaks, leaks, or
repairs to the water system.
1.5. Water withdrawal from publicly owned fire hydrants by authorized City personnel for street
maintenance, street cleaning, dust control, landscaping of City property, or cleaning of sanitary
or storm sewer lines.
1.6. Water withdrawal through a City of High Point approved hydrant meter water account
(Account) using a Hydrant Meter Assembly (Assembly) issued by the Director or his/her
authorized agent, as defined in this Policy.
1.7. Other uses as expressly authorized in writing in advance by the Director.
2.0 Definitions
For the purpose of this Policy, the following terms are defined to have the meanings described as
follows:
2.1. A “person” may include one or more of the following or their agents, employees,
representatives, directors, officers, members, partners, managers, superintendents, or legal
representatives: individuals, corporations, partnerships, joint ventures, associations, or other
entities recognized by the laws of the State of North Carolina.
2.2. “Fee Schedule” shall refer to the latest version of the Schedule of Fees for a Water Account
Using a Hydrant Meter Assembly as adopted by the High Point City Council.
City of High Point, North Carolina
Public Services Department
FIRE HYDRANT USE POLICY
City of High Point, NC Fire Hydrant Use Policy Page 2 of 6
2.3. “Business day” shall refer to a single calendar day in which the City of High Point Customer
Services Department is open to receive citizens for transactions and other utility customer
services. Saturdays, Sundays, and legal holidays established by the High Point City Council are
excluded.
3.0 Enforcement of Policy
Any person who opens, closes, damages, tampers with, connects to, or withdraws water from a City
fire hydrant in a manner that does not fully comply with the provisions of this Policy shall be subject
to one or more of the following enforcement actions, depending on the severity of the adverse
consequences and the previous history of similar occurrences:
3.1 An assessment for the value of the water withdrawn from a fire hydrant based on the City’s
retail rates in effect at the time;
3.2 An assessment for the value of the City’s cost of repair of damages to the water system,
including damages to the Assembly;
3.3 An assessment for the value of court costs, attorney fees, or other administrative costs for
claims consequential to acts prohibited by this Policy;
3.4 A civil penalty issued by the Director of up to one thousand ($1,000.00) dollars per violation;
3.5 An immediate suspension of privileges and closure of any Account issued to the person in
violation and demand to return the Assembly to the City within five business days of receipt of
notice;
3.6 Denial of a future application for an Account to use an Assembly to withdraw water from City
hydrants;
3.7 Discontinuation of service from any other active water account in the name of the person in
continuing violation of this Policy;
3.8 Removal of a City standard water service connection pipe from service to property owned by
the person or persons committing acts in continuing violation of this Policy; and
3.9 Criminal penalties pursuant to North Carolina General Statutes §14-151.1 or §14-159.1.
4.0 Water Service Account Using a Hydrant Meter Assembly
A person may obtain an Account to use an Assembly from the Director, or his/her authorized
agents, subject to the following conditions:
4.1 The person (Applicant) shall make application to the City of High Point for an Account on a form
designated by the Director at least five business days in advance of the date service is desired.
The application may request information sufficient to determine if the Applicant has the ability
to comply with the provisions of this Policy and other applicable federal, state, or local laws or
regulations, to include the following:
4.1.1 Purpose or purposes of water use;
4.1.2 Period of time in which water is needed;
City of High Point, North Carolina
Public Services Department
FIRE HYDRANT USE POLICY
City of High Point, NC Fire Hydrant Use Policy Page 3 of 6
4.1.3 Estimated volume of water required per month, or estimated total volume required if
period of time is less than one month;
4.1.4 Size of Assembly requested (must be a size provided by the City, as defined in the Fee
Schedule);
4.1.5 Make, model, color, and license plate identification for each mobile tanker truck that
may be used to receive and transport water received under the requested Account;
4.1.6 Street address or name of subdivision if water use is for a single property or subdivision;
4.1.7 Name of person requesting service and accepting payment responsibility, and billing
address; and
4.1.8 Other information applicable to the service application as determined by the Director.
4.2 The Applicant shall submit payment for the Application Fee and Deposit, as defined in the Fee
Schedule, before the application is considered complete.
4.3 The circumstances under which an application for an Account may be considered for approval
shall be limited as described below:
4.3.1 Withdrawal of water for construction work, to include masonry work, mortar mixing,
landscaping, dust control, pressure washing, soil compaction, hydro mulching,
demolition, or other appropriate construction purposes at locations where it is not
practical to use an existing or proposed permanent service connection. In cases where
the construction work will result in a structure requiring a permanent water service
connection, the Applicant may be denied an Account and requested to apply for the
permanent water service connection for water use during construction.
4.3.2 Street maintenance or street cleaning by authorized personnel of the North Carolina
Department of Transportation (NCDOT).
4.3.3 Contractors retained by the City of High Point or NCDOT for the purposes of dust
control, or the maintaining or cleaning of public streets, sanitary sewer lines, or storm
sewer lines.
4.3.4 Businesses for the purpose of cleaning private streets or parking areas, where it is not
practical to use a permanent service connection.
4.3.5 Special events, such as street fairs or carnivals, markets, or other temporary events.
4.3.6 Filling of commercial swimming pools or filling of residential swimming pools by a
business engaged in the service of filling pools as a contracted service to residents.
Residents proposing to fill a swimming pool for a single owner-occupied or lease
occupied dwelling must use the permanent residential service connection provided to
that property.
4.3.7 Filling of tankers for delivery of drinking water shall be prohibited except by emergency
relief agencies or their contractors, to supply water for basic public health and safety
needs during an emergency. Under such circumstances, the agency assumes full
responsibility for the appropriate cleanliness and disinfection of the tanker and all
appurtenances.
City of High Point, North Carolina
Public Services Department
FIRE HYDRANT USE POLICY
City of High Point, NC Fire Hydrant Use Policy Page 4 of 6
4.4 An application for an Account may be disapproved by the Director, or his/her authorized
agents, under any of the following circumstances:
4.4.1 Applicant is found to owe a delinquent debt to the City of High Point, unless the
applicant pays the debt in full, including all legitimate interest and delinquent charges,
prior to approval of the application;
4.4.2 Applicant is found to have not obtained a current privilege license with the City of High
Point for the business or commercial purpose for which the application is made;
4.4.3 Applicant has provided false information on the application or the application is not
complete; or
4.4.4 Other circumstances, as determined by the Director or as defined by the Customer
Services Policy, where the approval of the application is not determined to be in the
best interest of public health and safety.
4.5 If the application is accepted the Director or his/her authorized agents, the City will open an
Account and the approved application will state the conditions by which the Applicant receiving
approval (Customer) may withdraw water through a fire hydrant connected to the City’s water
system. These conditions may include the following:
4.5.1 An Assembly will be issued to the Customer. The Assembly will include a threaded
connection to a City fire hydrant, a water meter, a reduced pressure zone backflow
preventer, and a hand valve. Ownership of the Assembly, including the water meter,
will be retained at all times by the City of High Point. The City maintains a limited
number of Assemblies based on anticipated customer requests on a first-come, first-
serve basis and makes no obligation to furnish an Assembly anytime on demand.
4.5.2 The Customer will be provided instructions on the methods of attaching the Assembly to
a fire hydrant, bracing and supporting the Assembly, and opening and closing the fire
hydrant. The Customer is required to follow these instructions, and is responsible for
any damages resulting from failure to adhere to these instructions.
4.5.3 The approved application will specify the specific fire hydrants the Customer is
authorized to use.
4.5.4 The Customer may not disassemble or disconnect any parts of the Assembly. If a leak or
failure of operation occurs, the entire Assembly should be returned to the City.
4.5.5 The Customer shall abide by all provisions of this Policy and all conditions of the
approved application.
4.5.6 The Customer shall call the City of High Point Customer Services Department by the end
of the last business day of each month and report the meter reading on the Assembly.
4.5.7 The Customer shall pay the monthly bill issued by the City for the water metered
through the Assembly, at rates established in the City of High Point Water Rate Schedule
and Sewer Rate Schedule, on or before the due date, and shall be responsible for any
penalties and interest, as set forth in the Customer Services Policy, if payment is late.
Water Fixed Charges defined in the Water Rate Schedule are applicable to an Account
City of High Point, North Carolina
Public Services Department
FIRE HYDRANT USE POLICY
City of High Point, NC Fire Hydrant Use Policy Page 5 of 6
but Sewer Fixed Charges do not apply. Water Commodity Charges are applicable, and
Sewer Commodity Charges are applicable unless the Director, or his/her authorized
agent, has determined as part of the approved application that all purposes defined by
the Applicant for the use of water from the Account will not require present or future
sewer use.
4.5.8 The Customer shall protect the Assembly against damage and immediately report to the
City any damages that occur and the cause of the damages, if known.
4.5.9 The Customer shall permit the City to inspect the Assembly at any time a reasonable
request is made by the City.
4.5.10 During periods of time of drought when water use for specified purposes may be
restricted by the City of High Point under water conservation declarations, the Customer
shall not use the Assembly to withdraw water from the water system for those
restricted purposes.
4.5.11 The Customer shall not use the Assembly at any time to convey any material other than
treated water, and shall not use the Assembly to convey water from any location
connected to the City water system except the specific fire hydrants defined in the
approved application.
4.5.12 The Customer shall return the Assembly to the City at the location designated on the
approved application at the time the Customer desires to close the Account, or by the
date one year following the date of issuance of the Assembly currently used by the
Customer. If the Customer returns an Assembly to the City at the end of one year, in
good condition, the Customer is in compliance with this Policy and the conditions of the
approved application, and the Customer desires to continue to maintain the Account,
the Customer will be issued another Assembly to use for the next one year period. This
annual exchange of Assemblies permits the City to ensure that the water meter and the
backflow preventer on each Assembly in authorized use has been tested within a one-
year period. Failure to exchange the Assembly each year, or the continued use of an
Assembly after one year, are a violation of this Policy.
4.5.13 Within thirty days following the closing of an Account and the Customer’s return of the
issued Assembly to the City, the City shall inspect the Assembly for its physical and
operating condition and make any repairs if the Assembly has been damaged. The City
shall return the Customer’s Deposit, without the accrual of any interest, within this
thirty day period, less any outstanding charges for metered water use, less the cost of
any repair of damage to the Assembly, less any further charges to the Customer as
authorized by this Policy. If the Deposit is not sufficient to cover all charges, the Deposit
will be credited toward these charges and a final bill for the remaining balance will be
issued to the Customer.
4.6 An Account may be terminated by written notice to the Customer upon a finding that the
Customer has violated any condition of this Policy or the approved application. Upon receipt of
notice, the Customer shall immediately cease all water use under the Account, surrender the
Assembly to the City, and comply with other provisions of this Policy for closing an Account.
City of High Point, North Carolina
Public Services Department
FIRE HYDRANT USE POLICY
City of High Point, NC Fire Hydrant Use Policy Page 6 of 6
5.0 Appeals
An Applicant may appeal a decision by the Director, or his/her authorized agent, to deny an
Account, or a Customer may appeal a decision by the Director, or his/her authorized agent, to
terminate an Account against the Customer’s wishes or take enforcement actions against the
customer. The process for making an appeal, conducting a hearing, and the ruling on the appeal,
will be as defined by the City of High Point Customer Services Policy.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

1662 Fire Hydrant Use Information (City of High Point)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 5 August 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document