SERVICE AGREEMENT I. PURPOSE: The Town of Addison 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 TOWN OF ADDISON will begin service. In addition, when
service to an existing connection has been suspended or terminated, the water system will not re-establish service unless it has a signed copy ofthis agreement. II. RESTRICTIONS: The
following unacceptable practices are prohibited by State Regulations. A. No direct connection between the public drinking water supply and a potential source of contamination is permitted.
Potential sources of contamination are permitted; however, these potential sources of contamination shall be isolated from the public water system by an air-gap or an appropriate backflow
prevention device. B. 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. C. No connection which allows water to be returned
to the public drinking water supply is permitted. D. No pipe or pipe fitting which contains more than 8.0% lead may be used for the installation or repair ofplumbing at any connection
which provides water for human use. E. No solder or flux which contains more than 0.2 percent lead can be used for the installation or repair ofplumbing at any connection which provides
water for human use. 
III. SERVICE AGREEMENT: The following are the tenns of the service agreement between the Town of Addison (1be Water System) and Town of Addison (The Customer). A. The Water System will
maintain a copy of this agreement as long as the Customer and/or the premises are connected to the Water System. B. The Customer shall allow his property to be inspected for possible
crossconnections and other potential contamination hazards. These inspections shall be conducted by the Water System or its designated agent prior to initiating new water service, where
there is reason to believe that crossconnections or other potential contamination hazards exist, or after any major changes to the private water distribution facilities. The inspections
shall be conducted during the Water System's normal business hours. C. The Water System shall notify the Customer in writing of any crossconnection or other potential contamination hazard
which has been identified during the initial inspection or the periodic inspection. D. The Customer shall immediately remove or adequately isolate any potential cross-connections or
other potential contamination hazards on his premises. E. The Customer shall, at his expense, properly install, test and maintain any backflow prevention device required by the Water
System. Copies of all testing and maintenance records shall be provided by the Water System. IV. ENFORCEMENT: If the Customer fails to comply with the tenns of the Service Agreement,
the Water System shall, at its opinion, tenninate service or properly install, test and maintain an appropriate backflow prevention device at the service connection. Any expenses associated
with the enforcement of this agreement shall be billed to the Customer. 􀁃􀁕􀁓􀁔􀁏􀁍􀁅􀁒􀀧􀁓􀁁􀁄􀁄􀁒􀁅􀁓􀁓􀁾􀀺_________________________________ CUSTOMER'S SIGNATURE: _________________
DATE: 
, .> It Ji(f/()-t SERVICE AGREEMENT I. . PURPOSE; The· Town oC<\.ddiSon is responsihle 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 ofthe restrictions which are in plac;e to
provide this protection. The utility enforces these . restrictions to ensure the public health and welfare. Each customer must sigtt this agreement before the TOWN OF ADDISON will begin
service. In addition, when service to an existing connection has been suspended or termirurted, the water system will not re-establish service unless it has a sigtted copy ofthis agreement.
II. RESTRICTIONS. The following nnacceptable practices are prohibited by State Regulations: A. No direct connection between the public drinking water supply and a potential source of
contamination is permitted. Potential sources of contamination are permitted. Potential sources of contamination shall be isolated from· the public water system by an air-gap or an approprUite·
backflow preveution device. B. No cross-connection between the public driuldng water suppiy 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. C. No connection which allows water to be
returned to the public drinking water supply is permitted. . D. No pipe or pipe fitting which contains more than 8.0% lead may be used for the installation or repair ofplumbing at any
connection which provides water for human use. E. No solder or flux which contains Dlore than 0.2 percent lead can be used for the installation or repair.of plumbing at any connection
which provides· . water for human use. m. SERVICE AGREEMENT. The following are the terms of the service agreement between the Town of Addison (The Water System) and Town of Addison (The
Customer). A. The Water System will maintain a copy of this agreement as long as the Customer and/or the premises are connected to the Water System. 1 
B. The Customer shall allow his property to be inspected for possible crossconnections and other potential contamination hazards. These inspections shall be conducted by the Water System
or its designated agent ·prior to initiating new water service; when there is reason to believe that crossconnections or other potential contamination hazards exist; 'or after any .
major changes to the private water distribution fucilities: The inspections . 'shallbe conducted during the Water 'System's normal business hours. '. C. The Water System shall notify
the Customer in writing of any crossconnection or other potential contamination' hazard which has been . identified during the initial inspection or the periodic inspection. D. The Customer
shall immediately remove or adequately isolate any . potential cross-connections or other potential contamination hazards on his premises. E. The Customer shall. at his expense, properly
install, test and maintain any backflow prevention device required by the Water System. Copies of all testing and maintenance records shall be provided by the Water System. N. ENFORCEMENT.
If the Customer fails to comply with the terms of the Service Agreement, the Water System shall, at its option. either terminate service or· properly install, test, and maintain an appropriate
backflow prevention device at the service connection. Any expenses associated with the enforcement ofthis agreement shall be billed to the Customer. ;:I. d d r-e.SS 􀁾􀀠CUSTOMER'S 􀁾􀀮􀀮􀀮􀀮􀀮􀀬􀀮􀀠2