Lead Protection Program - Property Access Form

City of San Angelo Lead Protection Program

Water service line inspections

The City of San Angelo is asking you to assist with a lead inspection and water sampling program, per EPA and TCEQ requirements. To allow us to inspect your water service line, please click on the button below and complete the Authorization to Access Property form.

Accessing property details

Dear customer,

To continually improve the quality of our services, we are inspecting the water service lines that bring water to your residence from the water main.

For us to do this, we ask for your permission to come on the property and perform the following activities:

• Take photos of existing conditions of the property at the water meter.
• Determine the best location for two inspection holes. We will excavate one hole on each side of the water meter (public and private sides). Each hole will be between 5’-10’ from the meter box. Crews will minimize private property disturbance.
• Excavate two 12-to 18-inch holes that are 18-24 inches deep. The depth depends on where the service line is located at each residence.
• Inspect the service line to determine the pipe material and take photos.
• Fill the holes with the material they removed, restore the ground surface and take final photos.
• Restoration will be provided as needed.

If your property is in suitable condition, inspection activities could take approximately two hours to complete. Crews will not need to enter your home for this inspection.   

Permission to access private property shall be from the property owner only.

Please provide the following information:

1

Property owner first name:

 *

Property owner first name:

2

Property owner last name:

 *

Property owner last name:

3

Property house number:

 *

Property house number:

4

Property street name:

 *

Property street name:

5

Owner’s (or authorized representative’s) email address: 

 *

Owner’s (or authorized representative’s) email address:

6

Owner’s (or authorized representative’s) preferred phone number:

Owner’s (or authorized representative’s) preferred phone number:ext.

7

Are you the property owner?

Are you the property owner?

Yes

No

8

Are you a City of San Angelo employee?

Are you a City of San Angelo employee?

Yes

No

If your property is selected as an inspection site, you will be contacted via email with customer instructions prior to crews accessing your property.

Any of the above information that you share with us will be kept confidential and will be used only for coordination of this inspection and for continued water services to your residence.

By providing the property details and contact information above and submitting the Authorization to Access Property form, you give the City of San Angelo and its hired subconsultants permission to inspect the privately owned segment of your water service line.

9

Authorization to Access Property

Please fill in the blanks below, sign and date the Authorization to Access Property form before submitting:

I, _________, am an owner/authorized representative of the owner (or have permission to act on behalf of the owner) of the property located at __________.

I hereby give the City of San Angelo Water Utilities Department and/or its contractor(s) permission to access the property referenced above to inspect the privately owned section of the water service line. I understand that the inspection will involve minor digging so crews can make a visual inspection of the water service pipeline. I also understand that any holes created for the inspection will be refilled with the soil that was removed. I acknowledge that I have been provided information and documentation about the nature and extent of the work to be done, along with the general date and time it will take place, and I agree with the proposed process.

 *

Authorization to Access Property Please fill in the blanks below, sign and date the Authorization to Access Property form before submitting: I, _________, am an owner/authorized representative of the owner (or have permission to act on behalf of the owner) of the property located at __________. I hereby give the City of San Angelo Water Utilities Department and/or its contractor(s) permission to access the property referenced above to inspect the privately owned section of the water service line. I understand that the inspection will involve minor digging so crews can make a visual inspection of the water service pipeline. I also understand that any holes created for the inspection will be refilled with the soil that was removed. I acknowledge that I have been provided information and documentation about the nature and extent of the work to be done, along with the general date and time it will take place, and I agree with the proposed process.

Name

Date

Address

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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