Sewer/Water New Service Application

Document Overview

This is a Sewer/Water Service Application form for the Borough of Hollidaysburg, PA. It is used to request new water and/or sewer connections for residential or non-residential properties. The form must be filed at least two weeks prior to the requested service date.

Key Sections & Requirements

I. General Information

Applicants must provide:

• Applicant details: Name, phone, street address, city, zip.
• Property Owner details (if different from applicant): Same fields as above.
• Affected property address: Street, city, zip — where service will be installed.

Service Request Details

• Specify type of service: Water (with size connection requested) and/or Sewer (with size connection requested).
• Purpose for which service will be utilized.
• Distance, depth, and size of nearest public utility line for both water and sewer.
• Attach site plan(s) showing:
  • Location of site and building position
  • Desired location of service lines
  • Service line materials and sizes
  • Location of public utilities

Estimated Flow/Consumption

• For non-residential uses: Gallons per day (with estimated flow calculations or documentation).
• For residential uses: Number of dwelling units (EDUs).

Service Fees Table

Breakdown of fees for Sewer and Water services:

• Tapping Fee
• Connection Fee (including deposit if applicable)
• Customer Facilities Fee:
  • Water Meter
  • Radio Transceiver
  • Meter pit or vault
  • Installation service
  • Other (specify)
• Total amount due

Certification & Signature

Applicant certifies that:

• All information is true and correct.
• Application is authorized by property owner (or applicant is acting as agent).
• Agrees to comply with all applicable rules, regulations, rates, ordinances, codes, laws, and acts of:
  • Borough of Hollidaysburg
  • Hollidaysburg Borough Authority
  • Hollidaysburg Sewer Authority
  • Pennsylvania Department of Environmental Protection
  • U.S. EPA
• Agrees to be bound by any special conditions imposed by the Borough Manager.

Signature and date required at bottom.

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Departmental Use Only (Page 2)

Approval Section

• Grants service as requested for specified property.
• Conditions of approval (blank space for notes).
• Important Notice: Effective January 6, 1991, lead-containing materials are strictly prohibited in plumbing systems per Pennsylvania Plumbing System Lead Ban and Notification Act. Must certify only lead-free materials used before connection.

Signatures:

• Borough Secretary
• Date approved

Permit numbers (water and sewer) recorded here.

Fees Paid:

• Deposit Paid ($)
• Actual Connection Cost ($ for water and sewer)
• Credit or Payment Due ($)

Denial Section (if applicable)

If request is denied:

• Reason(s) for denial must be stated.
• Signed by Borough Secretary with date approved.

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Important Notes for Applicants

• Lead-free materials are mandatory for all new plumbing connections.
• Site plans must be attached and clearly show layout and utility locations.
• Estimated consumption data is required for non-residential applications.
• All fees must be paid; final amounts determined after inspection and installation.
• Applications not filed 2+ weeks in advance may be delayed or rejected.

This form ensures compliance with local and state regulations while facilitating safe, efficient utility service installation.