Courtesy Water Leak Adjustment Application

 
(Submission of this application does not guarantee approval. Eligibility is subject to compliance with the Town's Code and policies.)

 

Per Town Code 74-421 (c): Water Customers shall be responsible for and billed for all water delivered through the meter. In the case of a leak that has occurred inside the structure (internal leak) or a confirmed ground leak (outside), a courtesy leak adjustment may be applied for.

 

For an adjustment to be eligible for consideration, you must meet the following requirements.

 

Please note: Negligence, such as a spigot or faucet being left on, does not constitute a leak and is ineligible for adjustment.

 

1. Only property or building owners are eligible to apply for the Water Leak Adjustment.

 

2. Promptly and properly repair the leak within 10 days of discovery.

 

3. All leak claims are subject to review by the Town Meter Reader. This review is conducted to confirm the amount of potential leakage and to help determine the type of leak.

 

4. Provide proof of repair(s) to the Town of Herndon. This consists of invoice with descriptions of the repairs from the contractor or repair service. The receipts or invoices must correspond to the dates when the leak occurred. (Photos of cards or checking account statements do not constitute proof of repair.)

 

 5. Once all the required documents have been received, the application review can take up to two weeks.

 

6. Only submissions with required documentation will be reviewed.

 

7. If your application gets approved, please note that if you have an internal leak (within the building) the bill will be adjusted for only 66% of the excess water reflected on your bill, while a ground leak will be adjusted for 100% of the excess water reflected on your bill. Only specific charges related to consumption will be adjusted.

 

 8. If your application is approved, the approval amount will be credited to an outstanding bill. If you have already made a payment, the credit will be applied to future bills. We do not refund credits.

 

9. Not have received such credit during the five years preceding the date of discovery of the water service leak. (if a Leak Adjustment credit has been granted in the last 5 years, a new leak adjustment application may be eligible for approval per Herndon town code sec. 74-424)

 

10. No credit shall be allowed for the period beginning ten (10) days after the date such leak was discovered .

 

Personal Information

 *

Personal Information

Name	Address
Phone	Email
Account #

Type of Leak:

Type of Leak:

Toilet

Ground

Other Inside

Other (explain below)

If other, please explain:

If other, please explain:

Attach proof of repairs in the form of receipts or an invoice. (Please upload your documents below.)

Attach proof of repairs in the form of receipts or an invoice. (Please upload your documents below.)

Attach proof of repairs in the form of receipts or an invoice. (Please upload your documents below.) Click button for uploading file Clear Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

Attach proof of repairs in the form of receipts or an invoice. (Please upload your documents below.) Click button for uploading file Clear Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

Attach proof of repairs in the form of receipts or an invoice. (Please upload your documents below.) Click button for uploading file Clear Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

 

By signing this document, I am requesting to be considered for a leak adjustment on my/my tenant's water bill.  I understand this option is only available once every five years (in most cases). Furthermore, I understand that if a leak adjustment application is not approved, I am responsible for full payment of all billed usage.

Typing your name in the space below serves as your electronic signature.

 *

By signing this document, I am requesting to be considered for a leak adjustment on my/my tenant's water bill. I understand this option is only available once every five years (in most cases). Furthermore, I understand that if a leak adjustment application is not approved, I am responsible for full payment of all billed usage. Typing your name in the space below serves as your electronic signature.

Name

Date

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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