HYDRANT USAGE FORM
This form is only for non-metered hydrant usage.

The State of Massachusetts requires all water utilities to accurately document all fire hydrant usage on an annual basis. Your assistance is a truly important role in helping us to give the State the most accurate responses.

This data is for state compliance information - not for billing purposes!

If you have any questions or difficulty completing the form, please contact us at 203-445-7310 or 1-800-732-9678.

 Hydrant
Fire Department   DPW
Enter Name then Select from List:
    *Agency Name:
Enter Name then Select from List:
    *Agency Name:
    Tell us about yourself?
    *First Name
    *Last Name
    *Position / Title
    *Position / Title

Please fill in the following information as accurately as possible as Aquarion is required to report usage by individual water systems in our service territories.

    Water Usage Location Details
   
 /   /       
 
    *Street Address for Water Usage
     Address Line 2  
    *City
    *State
    *Zip Code
 -   
    Hydrant Details
*Number of Hydrants Used:
  Hydrant # 1
    Hydrant Number and/or Street
   *Reason for Water Usage
   *Other Reason
   *Reason for Water Usage
   *Other Reason
   *Were tanker truck(s) /
 street sweeper(s) filled:
Yes   No
   The following usage is required in gallons for State reporting purposes.
   *Truck Size
   Gallons
   *Number of Truck Loads
   
   *Length of Time Used
 Hours : 
 Minutes 
   
   *Hydrant issues
Yes   No
   *Select one or more hydrant issues (if applicable)
   
Doesn't Drain   
Stuck/Siezed   
Broken Collision Kit   
Bad Nozzle(s)   
Cap(s) Missing   
Hard to Operate   
Thaw Frozen Hydrant   
  Hydrant # 2
    Hydrant Number and/or Street
   *Reason for Water Usage
   *Other Reason
   *Reason for Water Usage
   *Other Reason
   *Were tanker truck(s) /
 street sweeper(s) filled:
Yes   No
   The following usage is required in gallons for State reporting purposes.
   *Truck Size
   Gallons
   *Number of Truck Loads
   
   *Length of Time Used
 Hours : 
 Minutes 
   
   *Hydrant issues
Yes   No
   *Select one or more hydrant issues (if applicable)
   
Doesn't Drain   
Stuck/Siezed   
Broken Collision Kit   
Bad Nozzle(s)   
Cap(s) Missing   
Hard to Operate   
Thaw Frozen Hydrant   
  Hydrant # 3
    Hydrant Number and/or Street
   *Reason for Water Usage
   *Other Reason
   *Reason for Water Usage
   *Other Reason
   *Were tanker truck(s) /
 street sweeper(s) filled:
Yes   No
   The following usage is required in gallons for State reporting purposes.
   *Truck Size
   Gallons
   *Number of Truck Loads
   
   *Length of Time Used
 Hours : 
 Minutes 
   
   *Hydrant issues
Yes   No
   *Select one or more hydrant issues (if applicable)
   
Doesn't Drain   
Stuck/Siezed   
Broken Collision Kit   
Bad Nozzle(s)   
Cap(s) Missing   
Hard to Operate   
Thaw Frozen Hydrant   
  Hydrant # 4
    Hydrant Number and/or Street
   *Reason for Water Usage
   *Other Reason
   *Reason for Water Usage
   *Other Reason
   *Were tanker truck(s) /
 street sweeper(s) filled:
Yes   No
   The following usage is required in gallons for State reporting purposes.
   *Truck Size
   Gallons
   *Number of Truck Loads
   
   *Length of Time Used
 Hours : 
 Minutes 
   
   *Hydrant issues
Yes   No
   *Select one or more hydrant issues (if applicable)
   
Doesn't Drain   
Stuck/Siezed   
Broken Collision Kit   
Bad Nozzle(s)   
Cap(s) Missing   
Hard to Operate   
Thaw Frozen Hydrant   
    Feedback (Optional)

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