The undersigned Applicant, owner, hereby requests a connection to SUBURBAN WATER’S distribution system to provide water service at a maximum flow rate of ______ gpm at a minimum residual pressure of 30 psi at the water distribution main to a private fire

1. Applicant agrees to purchase a single _______-inch diameter fire main connection at the unit price of $10,000.00. Applicant agrees to purchase and install a tapping-saddle/valve or tee/valve in the existing distribution main.
2. Applicant agrees to purchase and install a reduced-pressure detector (RPD) assembly type backflow prevention device with a 5/8-inch size by-pass water meter with remote-read antenna (supplied by SUBURBAN WATER) within a concrete vault located adjacent to the rights-of-way line on the Applicant’s property. Applicant agrees that the water from this connection is only to be utilized to fight fires through the sprinkler system and/or private hydrants, and no other use of water through this connection is allowed.
3. Applicant agrees to have the fire fighting system designed by a professional engineer, registered in the State of Kansas, in accordance with all Federal, State and local plumbing, building, fire codes and standards.
4. One month prior to the beginning of the installation of the fire fighting system, two complete sets of engineered stamped construction specifications and drawings shall be submitted to SUBURBAN WATER for review and approval. After review, one copy of the submitted specifications and drawings will be returned to the Applicant with comments noted or the acceptance indicated.
5. Applicant agrees to pay SUBURBAN WATER in advance for the following non-refundable costs:
   $10,000.00
6. Applicant further agrees that the tapping-saddle/valve or tee/valves are and shall remain, at all times the property of SUBURBAN WATER and the valves shall only be operated by SUBURBAN WATER personnel. This fire main connection may be removed by SUBURBAN WATER without notice upon discontinuation of service for any reason.
7. Applicant agrees to comply with the laws of the State of Kansas, the By-Laws ofSUBURBAN WATER, INC., and SUBURBAN WATER’S Rules and Regulations, aspresently exist, and as may be amended from time to time, are made a part of this Agreement,as though fully set out herein. If the Applicant and/or any of its contractors violate any of theRules and Regulations, the Applicant shall pay a penalty in the amount of $250.00 for thefirst offense and then the amount will double for each subsequent offense.
8. Pursuant to SUBURBAN WATER’S Rules and Regulations, there is no charge for thequantity of water utilized by the Fire Department to fight fires. Each fire main connectionshall carry the prevailing monthly minimum meter charge for the by-pass water meter.Failure to pay by the due date will result in a 10% penalty. Continued failure will result
   in disconnection of this fire main service.
9. Applicant agrees to claim no damage on account of the temporary stoppage of the flow ofwater or reduced pressure resulting from accidents, or when stoppage and pressure reductionare necessary for SUBURBAN WATER to make alterations, repairs, or improvements.
10. Applicant shall keep all plumbing fixtures and piping at this facility in good workingcondition and shall promptly eliminate all leaks.
11. Applicant agrees that the water service supplied by SUBURBAN WATER shall be for thesole use of the Applicant.
12. Applicant agrees not to extend or permit the extension of pipes for the purpose of
    transferring water from one property and/or structure to another.
13. Applicant agrees to not share, re-sell, nor sub-meter the water supplied by SUBURBAN WATER.
14. Applicant agrees that this fire main connection shall supply water to only one structure
    located on land within SUBURBAN WATER’S designated service area.
15. Failure to comply with all of SUBURBAN WATER’S Rules and Regulations shall result in
    the removal of this connection. Re-connection of this service, thereafter, shall result in a
    $500.00 service charge/violation fee.
    15.Applicant agrees that if after this water service is made available, the same is discontinued or
    disconnected for any reason, re-connection shall be upon the conditions established by
    SUBURBAN WATER.
16. Applicant agrees not to make any physical connection between a private water system and
    the fire main upstream of the backflow prevention device. Representatives of SUBURBAN
    WATER may, at any reasonable time, come on the premises where the water is being used
    for the purpose of conducting an inspection to insure compliance with provisions of thisUser’s Agreement. Violation of this provision shall result in disconnection of this service.
17. Applicant agrees to have the backflow prevention device tested prior to placing the fire fighting system into operation, and then annually thereafter by a certified backflow prevention specialist. The specialist’s written reports shall be submitted to SUBURBAN WATER within five days of each test. Failure to have the backflow prevention device tested when required may result in termination of the fire main service.

TOTAL COST…………………………………………………………………….… $10,000.00

APPLICANT INFORMATION: