2. WE NEED YOUR PERMISSION TO REPLACE YOUR LEAD WATER SERVICE LINE
   
   

   ACKNOWLEDGEMENT AND CONSENT FOR LEAD SERVICE LINE REPLACEMENT

   This form is to obtain your consent for Charleston Water System and its contractors to replace your water service line.

   Based on Charleston Water System records, your water service line likely consists of lead or galvanized steel. A water service line is an underground pipe that brings water from Charleston Water System’s water main in the street to your property, connecting to your home’s plumbing. Although lead isn't present in the water Charleston Water System sends to your property, lead can get into water as it moves through a lead service line.  

   As part of Charleston Water System’s SC DHEC/SC RIA State Revolving Fund Lead Service Line Replacement Project, Charleston Water System is replacing lead service lines within its service area, and Charleston Water System will replace your lead service line at no charge, which is at least $7500 cost savings to you based on Charleston Water System’s average cost to replace a lead service line.  

   Charleston Water System’s Responsibilities

   In replacing your lead service line, Charleston Water System will assume the following responsibilities:

   • Provide advance notice of replacement.  
   • Obtain necessary permits.
   • Replace lead service line.
   • Provide exterior flushing and instructions for interior flushing post-replacement.
   • Offer water quality tests before replacement, immediately after, and within six months after replacement.   
   • Provide lead-safe filter pitcher good for up to six months.
   • Restore worksite to previous conditions.

   Property Owner's Responsibilities

   Property owner agrees to undertake the following responsibilities:  

   • Anticipate a temporary interruption of water service to your property during the replacement of your service line.
   • Property owner or designee, at least 18 years old, must be at the property on the date and time scheduled for the lead service line replacement.
   • Property owner must provide reasonable, safe, and unencumbered access to the water meter and to the water service line inside the property. Move any items blocking access, such as vehicles, furniture, etc.
   • Charleston Water System will endeavor to minimize disturbances to exterior landscaping and hardscapes. Exterior landscaping, hardscaping or structures on the property that impede the replacement of the water service, may be disturbed as part of the service line replacement. However, Charleston Water System will restore the areas of disturbance to its previous condition, to the extent reasonably possible, including repairing items such as steps, patios, retaining walls, specialty or tinted concrete, structures of any type, grass, trees, shrubs, bushes, and flowers.  
   • After installation of the new service line, maintenance of the service line inside of the property line will remain the responsibility of the property owner.

   Certification of Ownership  

   By providing your consent to Charleston Water System and its contractors to replace your lead service line, you warrant the following:  

   • I certify that I am the owner, or the legal representative for the owner, of the below service address property and have the legal right and authority to execute this form and to grant Charleston Water System and its contractors the rights set forth in this form.  
   • I certify that if there are any tenants or other residents of the property other than the undersigned, I will provide them advance notice of the scheduled work.
   • I agree that I am responsible for ensuring that the property is in safe and sanitary condition and that the necessary plumbing shall be accessible for workers to complete the replacement of the service line and any required interior plumbing modifications.
   • I understand that if Charleston Water System determines that safe and sanitary conditions are not met, replacement will not be done.

   Authorization  

   I hereby authorize Charleston Water System and its contractors to:

   1. Replace the service line from the property line to the building’s inlet into my home.  

   ADDITIONALLY, I acknowledge and agree that on my own behalf, and on behalf of all other persons who could claim by or through me:  

   2. Except for the written obligations in this form, to release Charleston Water System and hold harmless Charleston Water System and its contractors from any and all claims, causes of action, damages, or losses, of any nature whatsoever, that I may have with respect to the work authorized by this form.  
   3. That I have accepted the offer of replacement of the service line voluntarily at no cost.
   4. That I fully understand the terms of this form and have the right to consult with an attorney if I have questions regarding this form.  

   YOUR IMMEDIATE RESPONSE IS REQUIRED: You must sign and submit this agreement in order for Charleston Water System to replace your service line. You own the service line, and Charleston Water System will not replace it without your consent. If you DO NOT wish for Charleston Water System to replace the service line, you may decline using the form in the lined box below.

   Please sign the appropriate box below

4. APPROVE LEAD SERVICE LINE REPLACEMENT: 
   
   

   I DO want Charleston Water System to replace my lead water service line. 

6. Property Owner - Full Legal Name

   Adding your name here equates to signing your name / signature.

8. Date
   Date
10. Address1
12. Address2
14. City
15. State
16. Zip
18. Phone Number
20. Email
22. OPTIONAL: Authorized Representative (Name, Phone, Email)

    If you cannot be present during the replacement, please provide the contact information of a representative, at least 18 years old, that you have authorized to provide us with access to your property (optional).

24. -----------------------------------------------------------------------

26. DECLINE LEAD SERVICE LINE REPLACEMENT:
    
    I DO NOT want Charleston Water System to replace my lead water service line. I acknowledge that a lead service line may cause increased levels of lead in my water.

28. Property Owner - Full Legal Name

    Adding your name here equates to signing your name / signature.

30. Date
    Date
32. First Name
33. Last Name
35. Email
36. Phone
38. Address
40. Address
42. City
43. State
44. Zip
46. Reason you decided to opt out:
Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

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