Open a Water Account In order for us to provide you with water service, please fill out the application below. Application for Water Service and Agreement for repairs and Maintenance to Water Service Pipe Full Name:*Service Address:*Billing Address (if different than service address):Is this a single family home?YesNoHow many living units are included?Phone:*Cellular Phone:Email: Upload Document 1Upload Document 2Upload Document 3Terms and ConditionsI hereby apply for water service and agree to take such service in accordance with the Pascoag Utility District rules, term and conditions, and schedule of rates governing this class of service. 1) The applicant agrees to pay a service charge for tapping the water main, with said service charge to be paid at the time of signing this application. 2) The applicant agrees to pay for the materials and labor used to connect this service from, and including, the curb stop to the place of service. 3) The applicant agrees to pay a one-time only, non-refundable meter use fee to Pascoag Utility District based on the size of the water meter. 4) The applicant agrees to pay a quarterly meter maintenance fee to cover any repair and/or replacement (including labor) of said water meter. 5) The applicant agrees to pay for all costs associated with the repair and/or replacement of water service lines and associated appurtenances (except the water meter), from, and including ,the curb stop (shutoff near road), to the applicant’s end point of use. 6) The applicant agrees to pay any and all charges incurred for digging. 7) The applicant agrees to provide and pay for any necessary blasting. 8) The Pascoag Utility District will not perform or be responsible for grading or landscape work in connection with installing, maintaining or repairing water service connections. 9) The applicant hereby grants all rights of easement to the Pascoag Utility District in connection with installing, maintaining or repairing of water service connection, and agrees to execute any and all documents reasonably necessary to record or perfect such easement. 10) If at any time the water is shut off for nonpayment of water bills, or for any reason for which the Water Department is not responsible, there will be a service charge for restoring the service. 11) The applicant agrees to pay all costs associated with the purchase of water and any costs associated with exploration for new water sources.Agreement:* I agree to the terms and conditions CaptchaNameThis field is for validation purposes and should be left unchanged.