Revised 8/15
Lancaster, SC
Hereinafter referred to as the “Utility”
Failure to do so may delay processing of the application.
Name: _________________________________________________ Account No: ______________________________
Social Security No: _______________________________________ Property Owner OR Rent/Lease
Drivers License No._________________________ State: ________ Date of Birth: ______________________________
Service Address: _________________________________________ Closing/Start Date: _________________________
Date of Application: ________________________
Billing Address: _________________________________________ Telephone No: Home: _______________________
_______________________________________________________ Work: _______________________
Name: _________________________________________________ Date of Birth: _____________________________
Social Security No: _______________________________________ Telephone No: Home: ______________________
Drivers License No. _________________________ State: ________ Work: ______________________
Type of Service:
Water Wastewater Water and Wastewater
Pursuant to 5 U.S.C. 552a(e)(3), as a part of the application for either water or wastewater service with Utility, you are
required to provide your social security number. It is not mandatory that you provide this information, however it is useful for
account verification purposes. When you call to speak with someone regarding your account, you will be asked to provide the
last four digits of your social security number to confirm you are the account holder. Should you refuse to provide this
information, Utility may not be able to process your application for water or wastewater service.
The undersigned (hereinafter referred to as “Applicant”) hereby makes application for water and/or wastewater service at
the above Service Address (“Premises”) and agrees to pay for said services at the applicable rate, based on water consumption as
measured by the Utility’s water meter. The Co-Applicant as indicated above is another designated person the Applicant may
choose to appoint on the application for receiving account information and any records of the account in the absence of the
The Applicant acknowledges that Utility has a perpetual easement in, over, under, upon, and across the above described
land, and with such easement the right to erect, install, lay, use, inspect, operate, construct, reconstruct, maintain, and repair any
service lines, and to perform any such other activities as may be necessary in connection with furnishing water and/or wastewater
service to the Applicant, and to have free access to the premises of the Applicant for the purpose of installing, inspecting, reading,
repairing and/or removing property, including water and/or wastewater infrastructure, of the Utility. Applicant further understands
LCWSD Fax Number - (803) 285-9574
Please send all faxes to (803) 285-9574
Revised 8/15
that the Utility shall have all of the rights set forth above even if Applicant’s water and/or wastewater service has been
disconnected at the time the employee, agent, or assignee of Utility accesses Applicant’s property. Should Utility require of
Applicant a recordable easement, Applicant promises to execute such an instrument upon presentation thereof by Utility, failing
which execution Applicant understands Utility may terminate or discontinue utility service to Applicant’s property.
The Applicant agrees that all meters, pipes, regulators, and any kind of water and/or wastewater infrastructure placed on
the Premises by the Utility shall not constitute a part of or an accession to the real estate but shall remain personal property, title
to which shall remain in the Utility. Applicant further agrees to keep in repair all appliances and piping on said Premises related to
the furnishing of water and/or wastewater service to the Premises (other than meters maintained by the Utility) and to report
immediately to the Utility any leaks discovered with respect thereto.
The Utility shall have the right and privilege to connect the service lines of any other applicant to the service lines
serving the Applicant which are located on the Premises and to thereby extend water and/or wastewater service to the adjoining or
nearby property so long as such extension does not adversely affect service which Utility renders to the Applicant.
The Utility shall have the right, but not the obligation, to inspect any water and/or wastewater system installation, either
before the Utility commences water and/or wastewater service to the Premises, or at any such later time as the Utility may deem
necessary or appropriate. The Utility further reserves the right to reject any piping or appliances related to the furnishing of water
and/or wastewater service which are not in accordance with any official code, or with the Utility’s standards; provided, however,
that any inspection or failure to inspect by the Utility shall not be regarded as an indemnity against defects in installation, piping,
or appliances and shall not render the Utility liable or responsible for any loss or damage resulting from defects in installation,
piping or appliances, or from any violation of any applicable federal, state, or local code(s) or from accidents or occurrences
which might occur upon the Premises.
If the Applicant is not the owner of the Premises when purchasing a new connection, the Applicant must obtain written
consent from the owner of the Premises with respect to the furnishing of water and/or wastewater service thereto by Utility.
Applicant must also sign this Contract, thereby assuming responsibility hereunder to the Utility.
The Applicant shall not connect or attempt to connect any dwelling or residence to the Utility’s water and/or wastewater
system, other than the dwelling or residence to be served by Utility pursuant to this Contract.
The Utility shall have the exclusive right to determine the location of any service lines connected to the Utility’s
distribution and/or collection system and to determine the allocation of water to the Applicant in the event of a water shortage.
Utility may, in the sole discretion of Utility, shut off water and/or wastewater service to Applicant if Applicant knowingly allows
a connection or extension to be made to his/her service lines for the purpose of supplying water and/or wastewater to another
person or entity.
The Utility shall have the right to determine meter and/or service line locations on the Premises. In most instances,
meters and/or lines shall be located adjacent to the Applicant’s property line at the location nearest to the Utility’s main.
The Applicant hereby agrees that: (1) if any bill for water and/or wastewater services performed under this or any like
Contract shall remain unpaid for thirty (30) days after such bill has been rendered; or (2) if the Applicant shall tamper with,
molest or otherwise interfere with any meters, lines, or other equipment of Utility; or (3) the Applicant shall otherwise be in
breach of this Contract or any of the “General Terms and Conditions” of the Utility which are now in effect or which may be
promulgated at some later time, then the Utility, at its option, shall have the right to terminate this Contract and any like contracts
providing for the service of water and/or wastewater to Applicant. Applicant agrees that Utility shall impose a non-payment fee
on Applicant in the sum required by the regulations of the Utility in effect at that time and service may be terminated any time
after non-payment fee is assessed.
It is hereby understood and agreed by and between the Utility and the Applicant that the Utility is under no obligation to
extend a service line to the Premises unless the Applicant has installed water consuming and/or wastewater discharging plumbing
facilities on the Premises which are equipped for immediate connection to the Utility’s system, or unless the Applicant has
furnished the Utility with satisfactory evidence that s/he has made satisfactory arrangements to have such facilities installed prior
to the time that the service lines are extended to the Premises.
The Utility reserves the right to refuse water and/or wastewater service to the Applicant and to refund his/her deposit, if
any, if, in the sole discretion of the Utility, service to the Applicant is uneconomical or if the Applicant is not located on or
adjacent to the Utility’s system.
LCWSD Fax Number - (803) 285-9574
Please send all faxes to (803) 285-9574
Initials: __________
Revised 8/15
The Applicant agrees that this Contract is subject to the “General Terms and Conditions” which are incorporated in this
Contract by reference. The “General Terms and Conditions” may be amended from time to time by the Utility and all
amendments or modifications to the “General Terms and Conditions” shall be binding upon the Applicant.
Once this Contract has been accepted by the Utility, Applicant agrees to pay Utility a non-refundable water and/or
wastewater connection and/or capacity fee in accordance with the standard rate then in force under the Utility’s regular schedule.
Applicant further agrees to accept and pay for water and/or wastewater service at the regular rate(s) established by Utility as soon
as such service(s) becomes available to Applicant. In the event that the Utility fails to complete the construction of service line(s)
to the Premises through no fault of the Applicant’s, the Utility shall reimburse Applicant for any connection and/or capacity fee
which the Applicant has paid to the Utility pursuant to this paragraph. Any cost incurred by Utility will be deducted from the
connection and/or capacity fee.
Applicant shall also pay to Utility, prior to commencement of water and/or wastewater service by Utility to Applicant,
such deposit as is required under Utility’s standard rate of charge. Such deposit shall constitute an advance payment by Applicant
against future water and/or wastewater service, repayable in water and/or wastewater service only, unless the Utility shall elect to
refund such deposit upon termination of water and/or wastewater service to Applicant.
If Applicant pays for water and/or wastewater service pursuant to the provisions set forth above, Applicant shall be
responsible for paying a minimum monthly charge to the Utility in accordance with the Utility rates then in effect, even if
Applicant elects not to make use of such water and/or wastewater service. By his/her signature herein below Applicant
acknowledges and agrees if the Applicant elects not to pay the minimum monthly charge to the Utility, the Applicant shall be
deemed to have forfeited Applicant’s interest in such service(s) and will be required to pay a new connection and/or capacity fee
at the rate then in effect prior to making use of such service(s).
In the event that Applicant fails to pay water and/or wastewater charges duly imposed by Utility in accordance with this
Contract and/or the Utility’s standard rate schedule, some or all of the following penalties shall be automatically imposed on the
Applicant: (1) If Applicant’s payment for such utility service is not received in the office of the Utility by the due date as
indicated on Applicant’s monthly bill, such penalty or penalties as are authorized by the General Terms and Conditions then in
effect will be added to Applicant’s next monthly bill; and (2) Applicant’s utility service may be disconnected without any prior
notice to Applicant; and (3) Utility may remove Applicant’s meter and retain Applicant’s initial connection and/or capacity fee, in
which case Applicant shall be required to pay a new connection and/or capacity fee at the rate then in effect prior to the Utility’s
reconnecting Applicant’s water and/or wastewater service.
Utility also reserves the right to refuse and return payments for less than the full amount billed. If the previous month’s
bill has not been paid after the current bill is mailed, Applicant shall be required to tender payment in full for the delinquent bill.
Utility is not responsible for mail service and the Applicant is responsible for payment of the monthly bill even though the
monthly bill may not be delivered by the mail service.
This Contract shall run with the Premises so long as service is provided thereto by Utility pursuant to this Contract and
shall bind any occupant on the Premises which is furnished any service hereunder.
Signed and Accepted _____________________________________ _____________________________________
Applicant Signature Printed Name
*Signed and Accepted ____________________________________ _____________________________________
Property Owner Signature Printed Name
Approved by ____________________________________________ Date _________________________________
Utility Rep.
*Property owner signature is not required for leases or rentals unless a new connection is purchased by the lessee or tenant.
LCWSD Fax Number - (803) 285-9574
Please send all faxes to (803) 285-9574
Lancaster County
Water & Sewer District “Serving Lancaster County For Over 50 Years”
I, ______________________________________________, a new homeowner located at
___________________________________________ in the Prestwick, Wakefield, or Burnside
Subdivision, acknowledge and understand that my residence within these subdivisions will have a special
sewer rate associated with its monthly bill from Lancaster County Water & Sewer District (LCWSD).
LCWSD has to rely on York County to treat the sewer from my residence which creates the need for the
special rate. The most current Rate Schedule can be provided by calling LCWSD’s office at 803-285-6919
during normal business hours.
___________________________________ ____________________
Homeowner’s Signature Date
Homeowner’s Printed Name
P.O. Box 1009 – Lancaster, South Carolina 29721
Phone 803-285-6919 – Fax 803-285-9574