DOE BAY WATER USERS ASSOCIATION

Physical location: 3634 Pt. Lawrence Road

Mailing Address:    P.O. Box 28         Olga, WA      98279

Voice and Fax: (360) 376-4990

www.doebay.net

 

APPLICATION FOR MEMBERSHIP

 

Name in which membership will be held: ­­ __________________________________________________________________

                                                                                    (As it appears on the Tax Roll))

Billing Address: ______________________________________________________________________________________

 

Telephone:  Day: ______________________Evenings: ________________________    Other: _______________________

 

Physical address or location of the property to be served:: ______________________________________________________

 

__________________________________________________________Tax Parcel Number (TPN): ___________________

 

Person from whom the property was purchased (if applicable): __________________________________________________

 

Number of living units:__ Description of the use of the membership:

Before you will be considered for membership in the Doe Bay Water Users Association (DBWUA), you must certify by your signature below that you understand and will meet all of the following requirements:

 

  1. I will use DBWUA supplied water only for the domestic use of one single family residence which does not include a rental room, bed and breakfast, guest house, apartment, live-in recreational vehicle, trailer, etc. and only on the above described property.

 

  1. I agree to be responsible for and pay for all water consumption fees and capital development fees incurred as a result of water service to my property.

 

  1. I am the owner of the above described property and the property lies within the DBWUA service area.

 

  1. I will adhere to all DBWUA promoted water conservation efforts and requirements including the use of low flow fixtures and restrictions on irrigation.

 

  1. I understand that membership and the use of water in DBWUA is conditional upon the terms of the Bylaws, Conditions of Service Governing the Use and Supply of Water, Distribution Design and Construction Standards, backflow protection program, policies and procedures, the laws and regulations of San Juan County and the State of Washington, and similar instruments that exist and as may be amended or created in the future. I understand that failure to comply with these requirements may result in DBWUA-imposed sanctions including actions taken by DBWUA to correct deficiencies in my use of water at my cost, fines, restrictions, termination of service, and/or forfeiture of my membership.

 

  1. I understand that I must pay all costs associated with extending DBWUA and/or private lines to my property, that all such installations must be approved by DBWUA prior to receiving service, and that I must only use DBWUA approved methods, materials, and contractors in the construction of such lines. I understand that I am solely responsible for my actions and the actions of my contractors insofar as they affect any part of the water system.

 

  1. I agree to install an approved fire hydrant if one does not exist within 1,000 road feet of a dwelling on my property or, alternatively, a San Juan County-approved fire suppression system.

 

  1. I understand that I am responsible for the installation, maintenance and ownership of my entire service line and that I may be required to upgrade lines owned by me in the future at my expense. If I share a service line with another property, I understand the rules and responsibilities associated with such a line. I am responsible for protecting the water meter from damage (e.g. traffic, freezing) and to keep it accessible at all times. I understand that the meter will be set as close to the main as practical at a location determined by DBWUA. I acknowledge that I have been informed that Class 200 polyethylene pipe is recommended for my service line.

 

  1. I agree to keep or allow DBWUA to keep all water line easements on my property in a grassy state to facilitate the inspection and repair of such lines.

 

  1. I understand that leaks can have a severe impact on the entire system and agree to promptly control and/or report leaks and to take such actions as will prevent leaks such as turning off the water to vacant properties at the meter, the installation of pressure reducing valves to protect lines, and the installation or replacement of lines with stronger materials.

 

  1. I understand that my membership is for a limited and discrete amount of water as defined by DBWUA and that my use of water will be taken only from fixtures downstream of a water meter.

 

  1. I understand that an inspection of my property, now and in the future, may be required as a condition of this membership and that upgrades or changes in accordance with DBWUA's standards or policies may be necessary to insure ongoing service to this property. 

 

  1. I understand that there will be inspection, maintenance, and repair activities on DBWUA infrastructure and that service may be disrupted as a result. I agree to take actions, at my own expense, necessary to mitigate such disruptions in my water service or to protect the DBWUA system such as filters, pressure reducing valves, storage tanks, and backflow prevention.

 

  1. I have enclosed a signed and notarized copy of DBWUA's standard member easement suitable for recording. This easement will permit the installation, maintenance, improvement, extension, and repair of water infrastructure on my property.

Special Terms and Conditions of Membership
 
 

 

 

 

 

 

 

 

 


Signature of Owner (s): ____________________________________________Date: _____________________

 

 

                                       ____________________________________________Date: _____________________

 

 

Approved for membership by the Board of Directors on:

 

______________________________________________

                                     Attest/Title