Town of Clinton Water Department Hydrant Use Request Form

A MINIMUM OF 48 HOURS NOTICE IS REQUIRED

(excluding weekends)

Maximum flow for Fire Department drills should be maintained at 1000 GPM or less.

If more than 1000 GPM is expected to be used, you must use a draft site or the hydrant at Spencer Lane.

If use of multiple hydrants are being requested, a seperate form must be filled out for each hydrant.

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Please provide the following information

Name of Fire Department/Company *

Date of Hydrant Use *

Month

Day

Year

Start Time *

Hour

Minute

End Time *

Hour

Minute

Municipality Where Hydrant Is Located *

Hydrant Number *

Nearest Cross Street *

Anticipated Flow Rate From Hydrant *

(Gallons Per Minute)

Quantity and Size of Connections *

	0	1
# of 5" Connections *	# of 5" Connections - 0	# of 5" Connections - 1

Quantity and Size of Connections *

	0	1	2
# of 2 1/2" Connections *	# of 2 1/2" Connections - 0	# of 2 1/2" Connections - 1	# of 2 1/2" Connections - 2

Additional Information

Requesting Party Information

Name *

Street *

City/Town *

Zip Code *

E-mail Address *

Phone Number: *

Submission Acknowledgement

By submitting this request, you are certifying that you are an authorized representative of your respective Fire Department and have been given the authority to request the use of a hydrant for training purposes. You further certify that at the completion of the training, you will promptly advise the Clinton Water Department of the amount of that was used (in gallons) during your training operations.

***** This request should not be considered approved until you receive verification from the Town of Clinton Water Department. *****

Leave this field blank

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Town of Clinton Water Department Hydrant Use Request Form