developer policy manual - Grand Strand Water and Sewer Authority
developer policy manual - Grand Strand Water and Sewer Authority
developer policy manual - Grand Strand Water and Sewer Authority
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APPENDIX 10<br />
GRAND STRAND WATER AND SEWER AUTHORITY<br />
“BACKFLOW PREVENTION SERVICE AGREEMENT”<br />
Customer Name: ______________________________<br />
Date: _________________<br />
Address: ____________________________________________________________<br />
Account Number: ___________________________ Phone No.: _______________<br />
Tax Map Number: _____________________________________________________<br />
Service Address: ______________________________________________________<br />
Contact Person at Service Address: ___________________ Phone No.: ___________<br />
• Customer agrees that as long as service is provided to this property, which<br />
requires a testable backflow prevention devise, GSWSA is authorized to conduct<br />
the annual inspection <strong>and</strong> maintenance of said device.<br />
• Customer agrees that a monthly fee will be added to my account for this service<br />
agreement.<br />
• Customer agrees that this monthly fee covers annual inspection fees, maintenance,<br />
repairs <strong>and</strong> any other cost associated with maintaining the backflow prevention<br />
device in proper working order during GSWSA normal business hours.<br />
• Customer agrees that should after-hours inspection or maintenance be required at<br />
the request of the customer or contact person, actual overtime costs will be added<br />
to the account.<br />
• Customer agrees to give GSWSA or its contracted tester access to the backflow<br />
prevention device to perform inspection or maintenance.<br />
• Customer agrees that GSWSA has the right to contract out with an approved<br />
backflow preventer tester to perform the inspection or maintenance at no<br />
additional cost to my account.<br />
• Customer agrees to sign the GSWSA Backflow Prevention Compliance Right-of-<br />
Way <strong>and</strong> Easement for the within service agreement to be valid.<br />
• The within service agreement shall bind the undersigned this, her, or their heirs,<br />
successors or assigns as long as a testable backflow prevention device is required.<br />
Date: _________________<br />
___________________________________<br />
Authorized Signature<br />
<strong>Gr<strong>and</strong></strong> <strong>Str<strong>and</strong></strong> <strong>Water</strong> <strong>and</strong> <strong>Sewer</strong> <strong>Authority</strong> July 2009 Appendices<br />
Developer Policy Manual Page 65
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