Request for work to be carried out - DOC by 00T06L9c


									Request for work RFW1                                                                               RFW1
for standard (25/32mm) and non-standard
(>32mm)water service connection(s) to a
requisitioned or existing water main.
also SLO application to connect
When you are ready for your service connection please complete and return this form either by fax on 01925
678926, by e-mail to or by post to United Utilities Water, Metering and Connections,
Ullswater House, Lingley Mere, Warrington WA5 3LP. If you need help or assistance please telephone 0845 0264296

Section 1: Applicant/developer/SLO (All connections)
Company : Please insert                                    Developer: Please select          SLO: Please select

Contact name: Please insert

Daytime telephone number: Please insert                       Mobile telephone number: Please insert

Fax number:     Please insert                                 Email: Please insert

Section 2: Site Location                                (All connections)
Development name (if any): Please insert                      Site agent name: Please insert

Address    Please insert                                      Town: Please insert                       Postcode:

Site office telephone: Please insert                          Mobile number: Please insert

Section 3: Standard connections only (metering and service arrangements)
    Internal meter as AMR                                                                    Wall mounted box as AMR
                                       In wall box as AMR Specifications Drawing 2
   Specifications Drawing 1:                                                                 Specifications Drawing 3
          Please select                               Please select                                Please select

1. Has payment been made (not applicable to requisitioned mains)                                   Please select

2. The service pipe has blue tracing mesh up to the property boundary                              Please select

3. The service pipe is clearly visible and sealed to stop contamination                            Please select

4. The service pipe is unjointed and long enough to reach the main                                 Please select

5. Each service pipe is labelled to show which plot it serves.                                     Please select

6. Any road crossing ducts are marked and visible.                                                 Please select

7. The service connection area is free from obstruction.                                           Please select

8. Local Authority confirmed postal addresses have been provided.                                  Please select

9. The declaration overleaf has been signed.                                                       Please select

Section 3a: Self lay connections only

Are you fitting the meter?                                                              Please select

Section 3b: Service pipe installation details                           (All connections)
Name of installer                                                Employer

Certificate number (attach certificate)                          Registration number

UUW inspection certificate number:                               Date        (no more than 3 months ago)

Section 4: Water harvesting and grey water systems                                         (All connections)
Please indicate below if any of the following have been installed

Rainwater Harvesting system Please select        Grey water system      Please select      Other please complete

RFW1 M&C/SA/1011v1.3
Section 5: Location of connections                                    (All connections)
                                                                                           Self lay only
UUW reference             Plot        Postal Address as Local Authority listing
                                                                                           Proposed connection date










Section 6: Non Standard service connections only
1. Has payment has been made (not applicable if connecting to a requisitioned main)                Please select

2. Is a valid disinfection certificate attached?           (63mm and above)                        Please select

3. Is a valid pressure test certificate attached?          (above 32mm)                            Please select

4 Is a valid water sample pass notification attached?      (above 63mm )                           Please select

5. Is a WIAPS certificate attached?                        (LESS than 63mm only)                   Please select

6. Is a UUW inspection certificate attached?               (63mm and above)                        Please select

7. Are there any Traffic Management restrictions in force?                                         Please select

Section 7: Declaration                                             (All connections)

I confirm that the supply pipes for all plots listed in Section 5 have been installed and all requirements listed above
have been met, and I understand that if the connection is aborted due to a failure of any of the above:

           I will be charged for an abortive visit charge

           I will need to complete any remedial work and submit a work request form

           The connection will be rescheduled

Name          Please insert                         Company           Please insert

Position      Please insert                         Date              Please insert

Telephone     Please insert                         Mobile phone      Please insert

UUW use only

Date received

UUW Ref No.

RFW1 M&C/SA/1011v1.3

                                                               United Utilities PLC

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