Registration Form For Property Owners Maintaining On-Site Sewage Facilities - Austin Water

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CITY OF AUSTIN
AUSTIN WATER
Utility Development Services Division
th
625 East 10
Street, Suite 715
Austin Texas, 78701
Registration Form for Property Owners Maintaining On-site Sewage
Facilities
I hereby certify that I am the owner of the on-site sewage facility (OSSF) located
at___________________________________________________________________(insert address) and
that I reside at this property. I further certify that I have completed the training required by Austin City
Code 15-5 to maintain my own aerobic OSSF. I fully understand the statements presented below and
accept the responsibilities contained therein:
1) It is my responsibility to ensure my aerobic septic system is properly maintained. This includes,
but is not limited to, checking the system a minimum of once every four months.
2) It is my responsibility to submit maintenance reports using City approved forms to the City of
Austin at least once every four (4) months.
3) I understand that I am not licensed by the State of Texas or the City to perform these duties on
properties other than my own homestead.
4) Once assigned to me, the City’s Homeowner Registration number is not transferrable to any
other person and I must notify Austin Water when I sell or transfer the property.
5) I agree to accept these responsibilities and sign this form acknowledging my duties.
Property Owner’s Information:
Printed Name:
Last Name
First Name
MI
Mailing Address (if different than the address provided above)
Number
Street
City/ Zip
Home Phone: ____________________ Cell Phone: ____________________
Email Address (Required if available): _________________________________________
Maintenance Course Completion Date __________________ (Copies of certificate must be included)
I certified under the penalty of law that to the best of my knowledge the above information is correct
and accurate
CITY OF AUSTIN USE ONLY
Reviewed By: _________________________ Date____________________
Home Owner Registration Number:_____________________________

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