Residential Application for Fire Protection Service

Step 1 of 2

MOON TOWNSHIP MUNICIPAL AUTHORITY

1700 Beaver Grade Road, Suite 200
Moon Township, PA 15108-3193
Phone: 412-264-4300 Fax: 412-262-9482
Email: customerservice@moontma.com

APPLICATION FOR SERVICE FOR HOUSES WITH A FIRE PROTECTION SYSTEM
(Required for Multi-Family Residential Buildings with 3 or More Units)

Service includes water, sanitary sewer, fire service, and solid waste/recycling where available.

RESIDENTIAL ACCOUNT INFORMATION:

Email Address(Required)

Service Address(Required)

Owner's Name(Required)

Co-Owner's Name

Billing Address

(If different than service address)

Owner's Phone(Required)

Co-Owner's Phone

Purchase Date(Required)

Previous Address(Required)

Number in Family

MOON TOWNSHIP MUNICIPAL AUTHORITY APPLICATION
FOR SERVICE WITH FIRE PROTECTION

PRIVATE RESIDENTIAL FIRE PROTECTION SERVICE

Select One:(Required)

Fire System after Water Meter

Fire System with Separate Fire Meter

Size of Service Line(s):(Required)

Size of Fire Service Meter (if applicable):

The owner is responsible for the design, size and functionality of the private fire suppression system. The owner is required to install and maintain a testable backflow preventer, which must be tested and inspected annually at their own cost. An administration fee will be charged quarterly basis for the inspection and maintenance of backflow device testing records.

I HEREBY MAKE APPLICATION FOR WATER, SEWER, FIRE PROTECTION, AND SOLID WASTE/RECYCLING SERVICE (AS APPLICABLE) AND AGREE TO BE GOVERNED BY THE RATES, RULES, AND REGULATIONS AS ADOPTED BY THE AUTHORITY. I FURTHER AGREE THAT I SHALL NOT PERMIT SURFACE OR ROOF DRAINAGE OR GROUNDWATER TO BE CONNECTED TO OR ENTER THE SANITARY SEWER SYSTEM FROM THE DESCRIBED PREMISES.

Signature(Required)

Date(Required)

INSURANCE COVERAGE FOR SANITARY SEWER BACKUPS

Following the unpleasant event of a sanitary sewer system backup, some sanitary sewer customers have learned that neither their insurance company nor the Moon Township Municipal Authority (MTMA) is responsible for damages incurred. The Moon Township Municipal Authority is not responsible for sudden and/or unforeseeable sanitary sewer backups and many homeowners' insurance policies do not provide coverage for these occurrences. Please check your property insurance to verify that you have adequate coverage. In the event of a sanitary sewer backup, you may call the MTMA to verify the sanitary sewer main is not clogged. If the backup is being caused by your sanitary sewer service line, it will be your responsibility to correct.

Customer Initial(Required)

Please consider signing up for Moon Township Alerts in order to receive important notifications from Moon Township and the MTMA at www.moontwp.com/news/MoonAlerts.php.

Services Applied for:

Water

Sewer

Solid Waste/Recycling

Activation Fee:

Date Paid:

Solid Waste Prepayment:

Date Paid: