Residences on Sewer and Private Well

Well Meter Reading Form

for Single Family Dwellings with a Metered Private Well

Installed in accordance with the Water Meter Rules and Regulations for Residential Properties Served by a Private Well and not connected to the Public Water Utility.

Address

Lot

Block

Phone

Property Owner Name

First

Last

Meter Reading Information

Date of Reading

When was your meter ordered?

Before June 2016

After June 2016

Meter Reading

Must be Seven Digits, last digit must be a zero

Meter Reading

Must be Eight Digits, including decimal

Example Water Meter

(Actual meter may look different)

Meter Reading Period

Quarter 1

Reading Date Between Mar. 15 - 31, Deadline Mar. 31

Quarter 2

Reading Date Between Jun. 15 - 30, Deadline June 30

Quarter 3

Reading Date Between Sep. 15 - 30, Deadline Sep. 30

Quarter 4

Reading Date Between Dec. 15 - 31, Deadline Dec. 31

Please Note:
a. $100.00 meter reading charge will be added to bill if annual reading is not submitted on time
b. If optional quarterly readings are taken, then all 4 quarterly readings are required in accordance with the Water Meter Rules and Regulations

Upload a meter reading photo

One file only.
128 MB limit.
Allowed types: gif, jpg, jpeg, png.

Certification

I certify that this meter reading is true and providing false data may be subject to a meter reading charge:

Print Name

Today's Date

Residences on Sewer and Private Well

Well Meter Reading Form

for Single Family Dwellings with a Metered Private Well

Example Water Meter

Certification

Community Center

Main Offices

Police