2. Hanover County Department of Public Utilities
   P.O. Box 470
   7516 County Complex Road
   Hanover, VA 23069-0470
   Phone: 804-365-6024
   Fax: 804-365-6245
   
6. Hanover County Water Leak Report
8. Date
9. Account Number
11. Account Name
12. Email Address
14. Address
16. City
17. State
18. Zip Code
20. Phone Number (Home)
21. (Cell)
23. Date Leak was Discovered
24. Date Leak was Repaired
26. Are you currently a Bank Draft customer?

    1. Yes

    1. No
28. If Yes, would you like your Bank Draft suspended?

    1. Yes

    1. No
30. ***If you suspend Bank Draft it will be the customer's responsibility to reestablish bank draft service.***
32. To expedite the processing of your Water Leak Report, please complete the information below:
34. How did you become aware of your leak?
36. Was there visual evidence of a leak, if so please explain
38. Was the leak inside or outside the structure?

    1. Inside

    1. Outside
40. Did the leak occur in an irrigation system?

    1. Yes

    1. No
42. Did the leak occur in a valve/spigot?

    1. Yes

    1. No
44. Did the leak occur in a swimming pool or pump?

    1. Yes

    1. No
46. Did the leak occur in equipment or due to a mechanical malfunction?

    1. Yes

    1. No
48. Has a previous leak report been submitted for this service address?

    1. Yes

    1. No
50. Repairs Completed By: (copies of receipts for repairs required)
52. Upload copies of receipts
54. Description of leak and completed repairs
58. Incomplete Leak Reports and Leak Reports submitted without a receipt for repairs will be returned to the customer without review.
60. If a second leak occurs after repairs completed by a homeowner (rather than a licensed professional plumber), an additional leak credit may not be considered.
62. Irrigation systems place a homeowner at a higher risk for leaks. Credits will not be approved for leaks related to use of an irrigation system. Regular maintenance by an irrigation professional as well as regular inspection is highly recommended to detect and promptly repair leaks.
66. I hereby certify that the above information is true and complete. I understand and acknowledge that I am responsible for prompt payment of all water and sewer services billed by the Hanover County Department of Public Utilities. I further understand that submission of this leak report is a request for consideration for a leak credit under Hanover County Code Sec. 23-64 and does not relieve me of responsibility for payment for water and sewer charges.
68. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
70. Electronic Signature
74. Hanover County Water Code
    Sec. 23-64. All metered water to be charged for. Beginning with the installation of the meter, with the exception of water used for fire protection, all water passing through a meter will be charged for, whether used or wasted; provided, however, where leaks occur in water pipes or metered services and the owner, agent or tenant promptly makes all necessary repairs, the director may rebate the amount in excess of double the amount of the average monthly or bimonthly consumption for the premises. Such average consumption shall be determined by averaging six (6) previous bills, provided sufficient consumption history is available. Otherwise the rebate calculation shall be based on double the first full billing period after all necessary repairs have been completed. No rebate shall be allowed for leaks attributed to irrigation systems.
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76. 1. Receive an email copy of this form.
77. Email address

    This field is not part of the form submission.

78. Submit Submit and Print

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