Fillable Repair Application Water Service Line Protection Program (Owatonna Public Utilities)

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Repair Application Water Service Line Protection Program (Owatonna Public Utilities)

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Owatonna Public Utilities
Engineering Department
208 South Walnut Ave.
P.O. Box 800, Owatonna, MN 55060
507.451.2480
Water Service Line Protection Program
Repair Application
Application Instructions:
It has been preliminarily determined that you have a water leak within the customer water piping system that may be
covered under the Water Service Line Protection Program (WSLPP). Additional review to verify Program eligibility
and scope of work must occur before OPU can proceed with payment for the repair. Please fill out the WSLPP
Repair Application and submit to the Owatonna Public Utilities Engineering Department with your request for
reimbursement as outlined in the Specifications for Water Service Line Protection Program. This must be filled out
by the property owner/program enrollee that has authority to authorize this work.
Owatonna Public Utilities
Engineering Department
208 South Walnut Ave.
P.O. Box 800, Owatonna, MN 55060
507.451.2480
Water Service Line Protection Program (WSLPP)
Repair Application
AddressofRepair:______________________________________________________________________Date:___________
Thispropertyis: owneroccupied tenantoccupied vacant
OwnerName:____________________________________________________________________________________________
MailingAddress:_________________________________________________________________________________________
City:__________________________________________State:______________________________Zip:__________________
DayPhone:________________24HrContactPhone:__________________Email:____________________________________
Briefnarrativeofwaterserviceissue:________________________________________________________________________
_______________________________________________________________________________________________________
Whendidtheissuefirstbecomeknowntoyou:________________________________________________________________
‐ AsOwneroftheproperty,IcertifythatIamawareoftheWSLPPSpecificationsandPolicy.Acopyofbothitemswere
giventoyouatthetimeofinitialwaterleakinspection,canbefoundontheOPUwebsitelocatedat
www.owatonnautilities.comorfromtheOPUEngineeringDepartment.
PropertyOwnerInitials______
‐ AsOwneroftheproperty,IhaveenteredintoaprivatecontractwithaContractormeetingtherequirementofthe
WSLPPSpecificationsandPolicy.IunderstandthatitismyresponsibilitytomaketheContractorawareoftheWSLPP
SpecificationsandPolicyandensurethattheirworkadherestoit.
PropertyOwnerInitials______
‐ AsOwneroftheproperty,IunderstandthattheWSLPPincludesonlytherepairoftheleakingwaterservicelineand
therestorationofsurfaceandsub‐surfaceimprovementslocatedwithinthepublicrightofwayasindicatedwithinthe
ProgramPolicyandSpecifications.TheOwnerisresponsiblefortherestorationofallsurfaceandsub‐surface
improvementsthatislocatedonprivateproperty.
PropertyOwnerInitials______
‐ AsOwneroftheproperty,Iagreetomarkthelocationofprivateutilitylines,ingroundirrigationsystems,electronic
petfences,etc.,priortoexcavation.Allcostsassociatedwiththeprotection,repairorreplacementofthesesystems
shallbebornebythepropertyowner.ThisincludessystemsthatareonprivatepropertyaswellaswithintheR/W.
PropertyOwnerInitials______
‐ AsOwneroftheproperty,Iunderstandthatallincidentalorconsequentialdamageresultingfromaservicelinebreak
isnotcovered.Damagecausedbynegligenceormaliciousintentisnotcovered.
PropertyOwnerInitials______
‐ AsOwneroftheproperty,Iagreetomakethepropertywheretheworkneedstotakeplaceavailableforaccessatall
reasonabletimesduringconstructiontoauthorizedrepresentativesofOPUforinspectionofthework.
PropertyOwnerInitials______
‐ AsOwneroftheproperty,IunderstandthatitismyresponsibilitytomakedirectpaymenttotheContractor
completingtherepairworkandthatOPUwillreimbursemeforonlytheworkthatisallowedwithintheWSLPP
SpecificationsandPolicy.
PropertyOwnerInitials______
IacknowledgethatIhavereadandunderstandtheaboveapplicationandcurrentProgramSpecificationsandPolicy.
PropertyOwnerSignature:
BY:_________________________________________________________________________Date:_______________________
(Signature/Print)
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Repair Application Water Service Line Protection Program (Owatonna Public Utilities)

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Completed 8 June 2021

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