New Meter Tap Request Step 1 of 15 6% Hardin County Water District No. 2 Meter Tap Application Service RequestedToday's Date* Date Format: MM slash DD slash YYYY Type of Service Requested*Water OnlySewer OnlyWater & SewerInstallation Requested:*Install Meter Box and Meter (Most Common)Install Meter Box and Meter - Leave Meter OffInstall Meter Box Only What type of connection are you applying for?*ResidentialCommericalIndustrialPublic AuthorityDo you have a well that has gone out?YesNo Property InformationDo you own or rent this property?*OwnRentMeter Size Requested5/8" (Tap Fee = $850)1" (Tap Fee = $1000)Larger (Tap Fee = Actual Cost)Please choose a service type?*Domestic (Most Common - Any service other than Irrigation or Fire Protection)IrrigationFire ProtectionPlease contact our office to complete your application at 270-737-1056. Primary ApplicantName* First Last Owner Name (If Different)SSN/Tax I.D.*DOB Date Format: MM slash DD slash YYYY License/ID#*Home PhoneCell Phone*Email* Is there an additional applicant?*YesNo Additional ApplicantName First Last SSN/Tax I.D.DOB Date Format: MM slash DD slash YYYY License/ID#Home PhoneCell PhoneEmail Service LocationService Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Lot Address (Optional) Lot Number Directions to Location:Other helpful information: My Billing Address is the same as my Service Address*YesNo Billing AddressMailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is account tax exempt?*YesNoTax Exemption Certificate Upload* Account HistoryHave you ever had service with Hardin County Water District No. 2*YesNoIf Yes, Please list the address Street Address Address Line 2 City Sewer User Agreement - By signing below, I hereby acknowledge that I have read and understand the Sewer User Agreement and agree to the terms contained herein.This Application for Sewer Service and Sewer User Agreement (the “Application and Agreement”) is made and entered into as of the date signed below by and between Hardin County Water District No. 2 (the “District”), P.O. Box 970, Elizabethtown, Kentucky 42702 and the “Customer(s)” whose names, service location, mailing address, and other relevant information are contained herein as the Primary Applicant and Additional Applicant”. WHEREAS, the Customer desires to obtain sewer service from the District and enters into this Sewer User Application and Agreement as required by the Rules and Regulations of the District. NOW THEREFORE, in consideration of the mutual promises, covenants, and conditions contained herein, it is agreed by and between the Parties as follows: Sewer Service. The District shall furnish, subject to the limitations set out in its Rules and Regulations now in force or as hereafter amended, sewer service for the Customer at the Service Location described in this Application and Agreement. Capacity Fee. The City of Elizabethtown charges the District a one-time Capacity Fee for each Service Location that connects to the District’s sewer system. The Capacity Fee is based upon the amount of Wastewater Treatment Capacity that will be utilized at the Service Location. The District “passes through” this Capacity Fee to the Customer without any mark-up. The Customer must pay this Capacity Fee to the District before the Customer can connect to the District’s sewer system. The Capacity Fee is based upon the size of the water meter which serves the Customer’s Service Location. For most residential customers, the Capacity Fee is $500. Customer Responsibility. The Customer shall engage the services of a licensed plumber to install the sewer service line from the residence or other building being served to the District’s collection main in accordance with the District’s specifications. This installation shall also be performed in accordance with local, state, and federal rules and regulations. Thereafter, the Customer shall remain responsible for maintaining his or her own plumbing and the sewer service line from the house or other building where sewer service is being provided up to, but not including, the Point of Service (clean-out fitting). The District shall be responsible for maintaining the clean-out fitting, its sewer lateral line, its sewer collection main, and all other facilities which comprise its sewer collection and conveyance system. No connection shall be made to the District’s sewer main except by a licensed plumber and then only under the supervision of, and inspection by, a duly authorized officer, agent, or employee of the District. Inspection Fee. The Customer shall be charged an inspection fee of $100 for the District’s representative to witness and inspect the construction of the Customer’s sewer service line and connection to the District’s collection system by the duly licensed plumber selected and paid by the Customer. Prohibited Connections. As a condition of receiving sewer service and for the Customer to be allowed to continue discharging into the District’s collection main, the Customer shall not permit discharges from sump pumps, septic tanks, roof runoffs, roof down spouts, basement wall seepage or floor seepage, storm drains, exterior foundation drains, other drains, other surface runoff or groundwater, or any other prohibited source to flow into or be connected to a building sewer or building drain, which in turn is connected directly or indirectly to the District’s sewer system. Any such connections which now exist shall be completely and permanently disconnected. The discharge of any water or wastewater into the District’s collection main by the Customer is not allowed unless in compliance with the provisions of the District’s Tariff. Prohibited Discharges. The Customer shall comply with Elizabethtown’s Sewer Use Ordinance and Pre-Treatment Program as codified in City of Elizabethtown Ordinance No. 11-2002, and any subsequent amendments thereto. The Customer shall not make discharges from sump pumps, septic tanks, roof runoffs, area drains, other drains, surface runoffs, storm drains, or any other prohibited source that flows into the District’s sewer system. The District shall take all actions reasonably necessary to prevent or disconnect any such discharge source. Easement & Ingress/Egress. The Customer hereby grants the District, its successors and assigns, a perpetual easement over, under, and upon land owned by the Customer, with the right to construct, lay, install, use, inspect, maintain, repair, replace, disconnect, and remove sewer lines, and appurtenant facilities. The Customer also grants the District the right of direct ingress and egress from the road or street to the Point of Service (clean-out fitting) for the purpose of performing necessary maintenance and inspection. The Customer shall also authorize the District’s duly authorized representative to access the premises, upon reasonable notice and at reasonable times, to inspect for possible sources of Inflow and Infiltration into the District’s sewer system. Rates and Charges. The Customer agrees to pay the current sewer rates and other charges which have been approved by the PSC and are set forth in the District’s Tariff. Monthly Rates Metered Usage* First 2,000 Gallons $30.00 Minimum Bill Over 2,000 Gallons $10.00 per 1,000 Gallons * All references to “Metered Usage” refer to metered water usage The Customer acknowledges that these sewer rates and other charges may be hereafter revised or modified by the District and approved by the PSC. The Customer also agrees to pay such revised sewer rates and other applicable charges. The failure of the Customer to pay sewer charges duly imposed by the District shall result in the automatic imposition of penalties as set forth in the District’s Tariff. These penalties shall include, but are not limited to, the following: (a) a late payment penalty charge of 10%; (b) termination of water and sewer service; and (c) a Reconnection Fee. Rules and Regulations. The Customer agrees to comply with, and be bound by, the District’s Rules and Regulations now in force or as hereafter duly and legally supplemented, amended, or changed and approved by the PSC. One Sewer Connection. A separate sewer connection shall be installed for each residence or business. If the Customer allows a connection or extension to be made to his or her sewer service line for the purpose of enabling another party, residence, or business to obtain sewer service, then the District shall discontinue sewer service to the Customer. No Tampering. The Customer shall not tamper with, or cause damage to, the District’s manhole covers, clean-out fittings, sewer lines, equipment, or other property. Both water service and sewer service shall be terminated if the Customer damages or tampers with the District’s property. The Customer shall pay the cost of repairing or replacing the damaged property. Neither water service nor sewer service shall be restored until the Customer has paid the cost of repairing or replacing the damaged property. In addition, the District reserves the right to file criminal charges against the Customer. Prior Indebtedness. The Customer’s Application and Agreement for sewer service will not be approved and no sewer service will be provided to the Customer if the Customer is delinquent or indebted to the District or if any adult member of the Customer’s household is indebted to the District and such indebtedness was incurred while that person and the Customer were members of the same household. This applies whether the delinquency or indebtedness is incurred at the Service Location for which this Application and Agreement is made or at any other Service Location. If the Customer fails to disclose to the District the Customer’s prior indebtedness or the indebtedness of an adult member of the Customer’s household and the District provides sewer service, the District may discontinue sewer service by discontinuing water service to the Service Location after providing the Customer with notice of the discovery of the indebtedness and providing the Customer a reasonable period of time to pay the outstanding debt. Joint Obligation of Adults. The District is providing sewer service to the Customer’s household. The Customer and all adult members of the Customer’s household, who benefit from the provision of sewer service to the Service Location designated above, are jointly and severally liable for payment of services rendered to that Service Location. Should a delinquency in payment for service to the Service Location occur, each adult member of the household at the time of the delinquency is responsible for the delinquency and is indebted to the District for the delinquent amount. The District may deny any future application or request for water or sewer service at any Service Location by any of those persons until the indebtedness is paid. Tariff. A complete listing of all the District’s sewer rates, charges, and conditions of service is contained in the District’s Rates, Rules, and Regulations (the “Tariff”). The District’s Tariff has been approved by the PSC. From time to time, it will be necessary for the District to revise its Tariff. All revisions to the Tariff must be approved by the PSC. The current Tariff is on the District’s website and is also on the PSC’s website at psc.ky.gov. The Customer may also obtain a copy of the Tariff from the District or may inspect the Tariff at the District’s office during normal business hours. False Information. The Customer represents and warrants to the District that the information provided in this Application and Agreement is true, correct, and complete in all material respects. The Customer acknowledges that any false or deliberately misleading information provided in this Application and Agreement shall be considered as an attempt to obtain sewer service through fraudulent means and may constitute grounds for discontinuance of Customer’s service at the Service Location designated in this Application and Agreement. Binding Contract. By signing this Application and Agreement, the Customer acknowledges that the terms of this agreement constitute a binding contract between the District and the Customer, and the terms and provisions of this Application and Agreement are legally enforceable against the Customer in accordance with its terms. THE SUPPLIER, REGARDLESS OF WHETHER THE USER IS CONNECTED TO THE SYSTEM, MAKES SEWER CHARGES TO THE CUSTOMER WHICH WILL COMMENCE ON THE DATE SERVICE IS AVAILABLE. I acknowledge that my application will not be processed until the District has received this completed application, along with a copy of my ID, deed or lease, tap fee and deposit. Primary Applicant Signature*Additional Applicant SignatureWater User Agreement - By signing below, I hereby acknowledge that I have read and understand the Water User Agreement and agree to the terms contained herein.Customers are responsible for contacting the District at (270) 737-1056 to schedule an on site meeting with a District Representative to place your meter stake. The meter will ONLY be cleared for installation once the meter location has been staked. The finished grade will be where the meter box is flush with the ground. Any alteration of the finished grade after installation will result in charges for repairs to include labor and materials. This agreement entered into between the user, whose address is stated above, hereinafter called “USER” and Hardin County Water District #2, 360 Ring Road, Elizabethtown, KY, hereinafter called “SUPPLIER” Whereas, the USER desires to purchase water from the SUPPLIER, the USER hereby enters into this water user agreement as required by the Tariffs of the SUPPLIER. Now therefore, in consideration of the mutual covenants, promises, and agreements herein contained, it is hereby understood and agreed by the parties hereto as follows: The SUPPLIER shall furnish, subject to the limitations set out in Rules and Regulations as filed with the Public Service Commission, that are now in force or as hereafter amended, such quantity of water as the USER may desire in connection with the property to be served by this agreement. The USER shall install and maintain at their own expense a service line which shall begin at the meter and extend to the dwelling or place of use. The SUPPLIER shall have exclusive rights to use such cutoff valve and water meter. REGARDLESS OF WHETHER THE USER IS CONNECTED TO THE SYSTEM, WATER CHARGES TO THE USER WILL COMMENCE ON THE DATE OF METER INSTALLATION. If the water system is constructed, but if the property covered by this agreement is not reached by the SUPPLIER'S water line, the connection fee will be fully refunded to the USER. Construction of water lines to serve the property covered under this agreement depends upon the feasibility, availability of funds for construction and approval of all local, state, and federal agencies having jurisdiction over this type of facility. THE SUPPLIER DOES NOT GUARANTEE WATER SERVICE WILL BE MADE AVAILABLE TO THE USER. The USER agrees to comply with and be bound by the Rules and Regulations of the SUPPLIER, now in force or as hereafter duly and legally supplemented, amended, or changed. The USER agrees to pay for water at such rates, time and place as shall be determined by the SUPPLIER, and agrees to the imposition of such penalties for noncompliance as are now set out in the SUPPLIER’S Rules and Regulations, or which have been or hereafter be adopted and imposed by the SUPPLIER. The SUPPLIER shall determine the allocation of water to the USER in the event of a water shortage, and may shut off water to the USER if they allow a connection or extension to be made of their service line for the purpose of supplying water to another party. In the event the total water supply shall be insufficient to meet all the needs of the USER, or in the event there is a shortage of water, the SUPPLIER may pro-rate the water available among the various users, on such basis as is deemed equitable by the GOVERNING BODY, and if at any time the total water supply shall be insufficient to meet all the needs of the users, the SUPPLIER must first satisfy all of the needs of all users for domestic purposes before supplying any water for livestock purposes and must satisfy all the needs of all users for both domestic and livestock purposes before supplying any water for garden purposes. The USER agrees that no present or future source of water will be connected to any water lines served by the SUPPLIER’S water lines and will disconnect from their present water supply prior to connecting to and switching to the SUPPLIER’S system and shall eliminate present or future cross-contamination in their system. The failure of the USER to pay water charges duly imposed shall result in the automatic imposition of the following penalties: Nonpayment after the due date of the original bill will result in a penalty of 10% percent of the delinquent account. Nonpayment within twenty days from the mailing date of the original bill will result in termination of service. In the event it becomes necessary for the SUPPLIER to terminate service, a termination fee of $50.00 will be asses if service has been terminated. The USER agrees to grant the SUPPLIER, its successors and assigns a perpetual easement in, over, under and upon land owned by the USER, with the right to erect, construct, install and lay, an thereafter use, operate, inspect, repair, maintain, replace, and remove water pipeline and appurtenant facilities, together and remove water pipelines and appurtenant facilities, together with the right to utilize adjoining lands belonging to the USER for the purpose of ingress to and egress from the said lands. I acknowledge that my application will not be processed until the District has received this completed application, along with a copy of my ID, deed or lease, tap fee and deposit. Primary Applicant Signature*Additional Applicant Signature Proof of OccupancyLease, Deed or other Proof Of Occupancy Required (Handwritten leases are not acceptable proof of residency.) Note** Deeds can be found on the Hardin County Clerk's Website at www.hccoky.org.Accepted file types: jpg, pdf, doc, docx, png, bmp, tiff, xls. Customer Deposit & FeesYOUR SIGNATURE ON THIS PAYMENT AUTHORIZATION FORM DENOTES ACCEPTANCE OF ALL TERMS & CONDITIONS INCLUDED ON THIS FORM AND THIS WATER USER AND/OR SEWER AGREEMENT AND ACCOUNT APPLICATION. *Please Note - Returned payments are subject to a $25.00 fee. Returned payment of a deposit or tap fee will result in termination of service without further notice until such deposit or tap fee is paid in full. Credit Card -For your convenience, Hardin County Water District No. 2 will use this authorization to charge your credit or debit card account for your customer deposit. There is a $2.50 processing fee for credit/debit card transactions. All other payments may be made in our office at 360 Ring Road in Elizabethtown.Customer Deposit Total: $60.00Processing Fee: $2.50 Payment Total: $62.50Card TypeAMEXVISAMasterCardDiscoverCard Number*Expiration Date*Security Code*Visa/MasterCard/Discover (3 Digits), Amex (4 Digits)Deposit* I understand that my application for new service will not be processed without receipt of deposit Cardholder Printed Name*Cardholder Billing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code *** The cardholder named above hereby authorizes Hardin County Water District No. 2 to charge my credit or debit card for the total payment amount above. Primary Applicant Signature*Secondary Applicant SignaturePAYMENT POLICY: -Hardin County Water District No. 2 requires payment of deposit in full, at the time services are requested. All services will be denied without complete payment. NO DEPOSITS WILL BE BILLED AND MUST BE PAID IN ADVANCE. TAX EXEMPT STATUS: -If you are exempt from paying sales tax, you must forward a certificate of exemption prior to the time of payment. VerificationPhoto ID* I understand that my application will not be processed without a photo ID. (Residential Accounts) Primary Applicant Photo ID*Accepted file types: jpg, pdf, doc, docx, png, bmp, tiff, xls.Additional Applicant Photo IDAccepted file types: jpg, pdf, doc, docx, png, bmp, tiff, xls.It is the responsibility of the applicant to submit necessary documentation. Until these necessary items are received in our office, applications will not be processed.NameThis field is for validation purposes and should be left unchanged.