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2. I. Purpose:
   The City of Angleton is responsible for protecting the drinking water supply from contamination or pollution which could result from improper private water distribution system construction or configuration. The purpose of this service agreement is to notify each customer of the restrictions which are in place to provide this protection. The utility enforces these restrictions to ensure the public health and welfare. Each customer must sign this agreement before the City of Angleton will begin service. In addition, when service to an existing connection has been suspended or terminated, the City of Angleton will not re-establish service unless it has a signed copy of this agreement.
4. II. Restrictions:
   The following practices are prohibited by State regulations:

   • No direct connection between the public drinking water supply and a private water system is permitted. Potential sources of contamination shall be isolated from the public water system by an air-gap or an appropriate backflow prevention device.
   • No cross-connection between the public drinking water supply and a private water system is permitted. These potential threats to the public drinking water supply shall be eliminated at the service connection by the installation of an air-gap or a reduced pressure-zone backflow prevention device.
   • No connection which allows water to be returned to the public drinking water supply is permitted.
   • No pipe or pipe fitting which contains more than 8% lead may be used for the installation or repair of plumbing at any connection which provides water for human use.
   • No solder or flux which contains more than 0.2% lead can be used for the installation or repair of plumbing at any connection which provides water for human use.
6. III. Service Agreement:
   The following are the terms of the service agreement between the City of Angleton and the customer:

   • The City of Angleton will maintain a copy of this agreement as long as the customer and/or the premises are connected to the City of Angleton.
   • The customer shall allow his property to be inspected for possible cross-connections and other potential contamination hazards. These inspections shall be conducted by the City of Angleton or its designated agent prior to initiating new water service; when there is reason to believe that cross-connections or other potential contamination hazards exist; or after any major changes to the private water distribution facilities. The inspections shall be conducted during the City of Angleton normal business hours.
   • The City of Angleton shall notify the customer in writing of any cross-connection or other potential contamination hazard which has been identified during the initial inspection or the periodic reinspection.
   • The customer shall immediately remove or adequately isolate any potential cross-connections or other potential contamination hazards on his premises.
   • The customer shall, at his expense, properly install, test, and maintain any backflow device required by the City of Angleton. Copies of all testing and maintenance records shall be provided to the City of Angleton.
8. Customer:
   Please print your name.
10. IV. Enforcement:
    If the customer fails to comply with the terms of the Service Agreement, the City of Angleton shall, at its option, either terminate service or properly install, test, or maintain an appropriate backflow prevention device at the service connection. Any expenses with the enforcement of this agreement shall be billed to the customer.
12. Electronic Signature*

    1. I agree

    By checking I agree, you agree and acknowledge your electronic signature is valid and binding in the same force and effect as a handwritten signature.
14. Date
    Date
15. Account Number
Leave This Blank:


17. 1. Receive an email copy of this form.
18. Email address

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19. Submit

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