Fillable EAST CENTRAL SPECIAL UTILITY DISTRICT

Fill Online, Printable, Fillable, Blank EAST CENTRAL SPECIAL UTILITY DISTRICT Form

Use Fill to complete blank online OTHERS pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

EAST CENTRAL SPECIAL UTILITY DISTRICT

On average this form takes 7 minutes to complete

The EAST CENTRAL SPECIAL UTILITY DISTRICT form is 5 pages long and contains:

  • 0 signatures
  • 0 check-boxes
  • 29 other fields

Country of origin: OTHERS
File type: PDF

BROWSE OTHERS 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
 
EAST CENTRAL SPECIAL UTILITY DISTRICT
PO BOX 570
ADKINS, TEXAS 78101
PHONE (210) 649-2383 FAX (210) 649-1462
1-800-354-2383
SERVICE APPLICATION AND AGREEMENT
Print Please
DATE: __________________ ACCOUNT #____________________
APPLICANT’S NAME: __________________________________________________
CO-APPLICANT’S NAME:_______________________________________________
BILLING ADDRESS: PRIMARY PHONE: (______) ________________________
__________________________________________________
__________________________________________________ ALT. PHONE: (______) _________________________
__________________________________________________ HIS______ HERS______
LEGAL DESCRIPTION OF PROPERTY (service address or subdivision with lot and block):
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
RECORDED DEED INFORMATION:
COUNTY___________________________ DATE__________________________
DOC# ___________________________________ BOOK___________________ PAGE________________
DRIVER’S LICENSE DRIVER’S LICENSE
APPLICANT’S # _______________________________ CO-APPLICANT’S # ______________________________
SPECIAL SERVICE NEEDS OF APPLICANT: ____________________________________________________________________
__________________________________________________________________________________________________________
SIGNATURE: _________________________________ SIGNATURE: __________________________________
(OFFICE USE ONLY)
NEW SERVICE: ___________ RE-SERVICE: ___________ TRANSFER: ___________
FEE PAID: _______________ DATE: ________________ RECEIPT: _____________
DEPOSIT:__________ INSTALLATION: __________
IMPACT FEE:___________ ROAD BORE:_________ LINE EXTENSION:__________
WATER ACQUISITION FEE: __________ TRANSFER FEE: __________ SERVICE INSPECTION: __________
(DEPOSIT)
REFUNDED:________________ APPLIED TO BALANCE:____________________ TRANSFERRED:_________________
NOTES: ________________________________________________________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
2
SERVICE AGREEMENT
THIS AGREEMENT is between EAST CENTRAL SPECIAL UTILITY DISTRICT, a District
organized under the laws of the State of Texas (hereinafter called a District) and
__________________________________________(hereinafter called the Applicant and/or
Customer),
The District shall sell and deliver water and/or sewer service to the Applicant and the
Applicant shall purchase, receive, and/or reserve water and/or sewer service from the District in
accordance with Order Setting Rates and Policies of the District as amended from time to time
by the Board of Directors of the District. Upon compliance with the District’s Rules, including
payment of an Application Fee, the Applicant qualifies as a new applicant or continued
Customer as a Transferee and thereby may hereafter be called a Customer.
The Customer shall pay the District for service hereunder as determined by the
District’s Order Setting Rates and upon the terms and conditions set forth therein, a copy of
which has been provided as an information packet, for which Customer acknowledges receipt
hereof by execution of this Agreement.
The Board of Directors shall have the authority to discontinue service and cancel the
account of any customer not complying with any policy or not paying any utility fees or charges
as required by the District’s published rates, fees, and conditions of service. At any time service
is discontinued, terminated or suspended, the District shall not re-establish service unless it has
a current, signed copy of this agreement.
All water shall be metered by meters to be furnished and installed by the District. The
meter connection is for the sole use of the Customer and is to provide service to only one (1)
dwelling or one (1) business. Extension of pipe(s) to transfer utility service from one property
to another, to share, resell, or sub-meter water to any other persons, dwellings, businesses,
and/or property, is strictly prohibited.
The District shall have the right to locate water service meter and the pipe necessary to
connect the meter on the Customer’s property at a point to be chosen by the District, and shall
have access to its property and equipment that may be upon Customer’s premises at all
reasonable and necessary times for any purpose connected with or in the furtherance of its
business operations, and upon discontinuance of service the District shall have the right to
remove any of its equipment from the Customer’s property. The Customer shall install at their
own expense any necessary service lines from the District’s facilities and equipment to the point
of use, including any customer service installation valves, backflow prevention devices, clean-
outs, and other equipment as may be specified by the District. The District shall also have
access to the customer’s property for the purpose of inspecting for possible cross-connections
and other unauthorized plumbing practice.
The District’s authorized employees shall have access to the Customer’s property,
premises, and facilities at all reasonable times for the purpose inspection, to insure compliance
with state required Minimum Acceptable Operating Practices for Public Drinking Water
Systems, as promulgated by the Texas Natural Resource Conservation Commission or successor
agency, applicable plumbing codes, and utility construction standards. The District strictly
prohibits the connection of service pipelines from its water service meter to any private well or
other unknown water supply.
3
The District is responsible for protecting the drinking water supply from
contamination or pollution, which could result from improper plumbing practices. The
service Agreement serves as notice to each customer of the plumbing restrictions, which
are in place to provide this protection. The District shall enforce these restrictions to
ensure the public health and welfare. The following unauthorized practices are prohibited
by State regulations:
1. No direct connection between the public drinking water
supply and a potential source of contamination is permitted.
Potential sources of contamination shall be isolated from the
public water system by an air-gap or an appropriate backflow
prevention device.
2. No cross-connection between the public drinking water
supply and a private water system is permitted. These
potential threats to the public drinking water supply shall be
eliminated at the service connection by the installation of an
air-gap or a reduced pressure-zone backflow prevention
device.
3. No connection which allows water to be returned to the
public drinking water supply is permitted.
4. No pipe or pipe fitting which contains more than 8.0% lead
may be used for the installation or repair of plumbing at any
connection which provides water human use.
5. No solder or flux which contains more than 0.2% lead can be
used for the installation or repair of plumbing at any
connection, which provides water for human use.
6. No plumbing fixture us installed which is not in compliance
with state approved plumbing code.
The District shall maintain a copy of this Agreement as long as the Customer and/or
premise is connected to the public water system. The Customer shall allow his property to be
inspected for possible cross-connections and other unauthorized plumbing practices. These
inspections shall be conducted during the District’s normal business hours.
In the event the total water supply be insufficient to meet all of the needs of the
Customers, or in the event there is a shortage of water, the District may prorate the water
available among the various Customers on such basis as is deemed equitable by the Board of
Directors and may also prescribe a schedule of hours covering the use of water for garden
purposes by particular Customers and require adherence thereto to prohibit the use of water for
garden purposes; provided that, if at any time the total water supply be insufficient to all of the
needs of all Customers, the District must first satisfy all of the needs of all Customers for
domestic purposes before supplying any water for livestock purposes before supplying any
water for gardening purposes.
By execution hereof, the Customer shall hold the District harmless from any and all
claims for damages caused by service interruptions due to waterline breaks by utility or like
contractors, tampering by other customers of the District, normal failures of the system, or other
events beyond the District’s control.
4
The Customer shall grant to the District, now or in the future, any easements of right-
of-way for the purpose of installing maintaining, and operating such pipelines, meters, valves,
and any other equipment which may be deemed necessary by the District to extend or improve
service for existing or future customers, on such forms as required by the District.
By execution hereof, the Applicant fully guarantees payment of all rates, fees, and
charges due on any account. This guarantee pledges any and all Customer Fees against any
balance due the District. Liquidation of any Customer Fee shall authorize discontinuance of
service under the terms and conditions of the District’s Rules.
By execution of this Service Application and Agreement, the Applicant agrees that non-
compliance with the terms of this Agreement by the Applicant shall constitute denial or
discontinuance of service until such time as the violation(s) are corrected to the satisfaction of
the District.
Any misrepresentation of the facts by the Applicant on any of the four pages of this
Agreement shall result in discontinuance of service pursuant to the terms and conditions of the
District’s Rules.
CLOSED SYSTEM INFORMATION
In all new meter installations and meter replacements a check valve is installed, creating
a closed system.
A closed system is created when an approved backflow prevention assembly or
a check valve (not approved for backflow prevention) is installed at a customer’s
service connection. The backflow prevention assembly or check valve does not allow
water to flow backwards from the customer’s private water system into the Public
Water System’s distribution. Thermal expansion is a result of heating water. When
water is heated, its density decreases and its volume expands. Backflow prevention
assemblies and other one-way valves installed at a customer’s service connection
eliminate a path for expanded water to flow back to the distribution system, resulting in
increased system pressure. This increase in pressure can result in: pressure surges,
dripping faucets, chronic or continuous dripping of temperature and pressure –relief
valves on hot water heating tanks, and other mechanical problems with hot water
heating tanks, including distortion and rupture.
SIGNED this the ______ day of ________________, 20_____.
_________________________________________
Signature of Applicant
ACCEPTED AND APPROVED
______________________________________
President
5
YOU CAN NOW REQUEST THAT PERSONAL INFORMATION
CONTAINED IN OUR UTILITY RECORDS
NOT BE RELEASED TO UNAUTHORIZED PERSONS
The Texas legislature recently enacted a bill, effective September 1, 1993 allowing utility districts to give
their customers the option of making the customer’s address, telephone number, and social security
number confidential.
WE MUST STILL PROVIDE THIS INFORMATION
UNDER LAW TO CERTAIN PERSONS
We must still provide this information to (1) an official or employee of the state or a political subdivision
of the state, or the federal government acting in an official capacity; (2) an employee of a utility acting in
connection with the employee’s duties; (3) a consumer reporting agency; (4) a contractor or
subcontractor approved by and providing services to the utility or the state, a political subdivision of the
state, the federal government, or an agency of the state or federal government; (5) a person for whom the
customer has contractually waived confidentiality for personal information; or (6) another entity that
provides water, wastewater, sewer, gas, garbage, electricity, or drainage service for compensation
If you would like your personal information confidential please fill out and sign the bottom portion and
return as soon as possible. (Separate return for each account) Remit to: East Central Special Utility
District at P. O. Box 570 Adkins, Texas 78101
Yes, I want you to make my personal information (address and telephone number) confidential.
_______________________________________ ______________________
Name Account Number
_______________________________________ ______________________
Address Telephone Number
_______________________________________ ______________________
City, state, Zip Code Signature
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

EAST CENTRAL SPECIAL UTILITY DISTRICT

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 26 February 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document