Town of Tolland Water Supply System Application for Domestic Water Supply Service Water Service Connection/System Repair

Transcription

1 Town of Tolland Water Supply System Application for Domestic Water Supply Service Water Service Connection/System Repair Application Number Date PROPERTY OWNER INFORMATION Name Phone Number Street Location Mailing Address (If different) SERVICE REQUESTED (Check those that applies) Residential Commercial Industrial Private Fire Protection Construction New Repair Well Replacement Irrigation System Sprinkler System Gallons (Est. Daily Average) If seasonal, explain PERMIT APPLICANT Name Address Phone Numbers License Type License Number Expiration Date WATER UTILITY ASSESSMENT (Please verify information at Tax Collector s Office and attach to application) Assessment - Current Value Paid in Full Date Installment Balance Date of most recent payment BUILDINGS TO BE SERVED Single Family Multi-Family/Number of Units / Commercial Industrial Irrigation Meter Size(s)

2 ABANDONMENT OF EXISTING WELL Attach Copy of Well Permit WATER SERVICE SYSTEM TO BE CONNECTED Tolland Water System Village of Crystal Springs Individual Well CT Water Company System. (A Town of Tolland permit is not required for connection of water service. Permits must be obtained from the Connecticut Water Company, (800) An information copy of this form is required for coordination with other local permitting requirements. All other Town permits such as building, plumbing, electrical, and waste water must be obtained. FIRE DEPARTMENT INFORMATION Number of Private Hydrants Amount of Water in Storage Fire Pump Size If Sprinklers are required, list the type and model of back flow device Sprinkler System Flow, GPM IRRIGATION SYSTEM If an irrigation system is to be installed, the owner occupant is required to: 1. submit a plan for the system to be installed which must show the maximum instantaneous demand, the number hours per day, days per week and total number of days per season the system will be utilized; 2. install an approved back flow device; 3. have the system inspected annually; and 4. provide the water commission with an annual inspection report by April 1. (Failure to meet inspection requirements and file certification reports will result in disconnection of service. Use of irrigation systems must be discontinued in the event of a local or State issued conservation alert.) System: Plan Submitted Maximum Instantaneous Demand No s of Hours Per Day No s of Days Per Week Permit Limits

3 FEES ACCOMPANING THIS APPLICATION (Fees must be paid separately, make checks payable to the Town of Tolland) 1. Connection Fee Cash/Check # Date (Residential fee $1,000 other fees see chart on back of application) 2. Meter & Horn Setup ($525) Cash/Check # Date (Meter must be installed by the system operator) 3. Inspection fee ($40) Cash/Check # Date Total Paid Date 4. No fee (Information application only) (Connection to Connecticut Water Company System) Applicant s Signature DATE Copies of the application to Tax Collector, Assessor, Town Engineer, Finance Department, Building Inspector, Sanitarian, Fire Marshal, Fire Department, Water Commission, and Connecticut Water Company (if utility related permit). Date Distributed

4 For Office Use Only Bond: Insurance: Issue Date: Record Drawing: Date of Connection: Inspected & Approved by: Date: These fees are subject to change depending on application. Connection Fee Schedule Building Gross Square Footage Connection Fee 5,000 sf or less $1,000 5,001 sf to 10,000 sf $2,000 10,001 sf to 20,000 sf $3,000 20,001 sf to 30,000 sf $4,000 30,001 sf to 40,000 sf $5,000 40,001 sf to 50,000 sf $6,000 50,001 sf to 60,000 sf $7,000 60,001 sf to 70,000 sf $8,000 70,001 sf to 80,000 sf $9,000 80,001 sf to 90,000 sf $10,000 90,001 sf to 100,000 sf $11, ,001 sf to 110,000 sf $12, ,001 sf to 120,000 sf $13, ,001 sf to 130,000 sf $14, ,001 sf to 140,000 sf $15, ,001 sf to 150,000 sf $16,000

5 Instructions, Fee Schedules, and Permit Requirements PERMIT REQUIREMENTS Prior to any connection to a domestic water utility or installation of an on-site water supply system, a valid permit must be obtained prior to construction, repair, and/or modification to an existing system. Permits are based upon a Town approved plan with an as built plan being filed when work is completed following Town final inspection and approval. CONDITIONS OF PERMIT The applicant certifies that he/she is the owner of record or authorized agent acting on behalf of the owner, and agrees to conform to the rules and regulations established by the Town of Tolland and the Tolland Water Commission and this application is subject to investigation before final approval. Further conditions of the permit shall include: 1. All appropriate fees shall accompany the application. These fees include service connection ($1,000 for residential) (Commercial please see fee schedule), meter horn set up ($200), and inspections ($40). 2. All meter horn set work shall be performed by the system operator, personnel from the Connecticut Water Company. 3. Assessment fee shall be paid as part of the fee schedule. When the water system was constructed each abutting property was assessed a fee for construction of service lines. Payment of this fee is only required when the hook up is undertaken. Information of the current fee may be obtained from the Tax Collector. Fee is only applicable if not previously paid. 4. Accepting rules regulations governing the operations of the Tolland Water System including State Laws, State Regulations, and town codes 5. Application is void if service is not installed within one year. 6. Installation requirements: of the Tolland Town Codes sets forth service pipe requirements. (All service pipes from the street line to the building are installed by licensed plumbers retained by the owner and paid by the owner. All such installations between the street line and meter setting shall be laid in a manner prescribed by the Water Department and subject to inspection, before backfilling, by a representative of said Department. Further such service pipes shall be of Type K copper tubing, or other approved pipe, at least one inch and not more than two inches inside diameter. Pipes over two inches in diameter shall be of Class 150 American Water Association standard cast iron water pipe. All pipes shall be laid so as to have at least 4 1/2 feet of cover and shall not be laid in a trench with other pipes or conduits unless separated by a safe distance as approved by the inspector. Service pipes shall be laid at least 10 feet away from any septic tank leaching field. 7. By special request from the applicant, SDR-9. PR 200_ plastic pipe can be substituted for Type K copper for service connections for the Tolland Water and the Village of Crystal Springs Systems, with prior approval from the Tolland Water Commission or the Tolland Town Engineer acting in its behalf. If such approval a metal wire must parallel the plastic piping so as to identify the location of the water service to identify service locations for call be for you dig. 8. Any irrigation systems shall meet all conditions of the permit in the IRRIGATION SYSTEM section of the permit. 9.The contractor is responsible for all call be for you dig requirements. 10.Conform to State water and sewer regulatory requirements for meeting minimum separation of water and sewer service lines. Water and sewer service lines are to be maintained in separate trenches 10 feet apart in a horizontal direction except when this standard can not be met, water service shall be on a separate shelf with water service lines a minimum of 18 inches above sewer service and off set horizontally by a minimum of 12 to 18 inches. State Water & Sewer Service Line Separation Requirements Where sewer and water lines cross, see Connecticut Public health Code19-13-B103 and Technical Standards for Subsurface Sewage Disposal Systems, most recent revisions.