Work Authorization and Disclaimer Form

Location and Access to Well

In many cases, well repairs require heavy equipment and access to the well head for personnel and heavy equipment. For wells where the location is not known, this may require third party location services. Access may also require tree removal, grading, snow removal or other site preparation. In special circumstances, other third party services (crane services, etc.) may be required. Customer acknowledges that it is his/her responsibility to provide or (contract to provide) well location and access.

Inherent Risks

Customer acknowledges that well repairs involve inherent risks. These risks include, but are not limited to, landscape impacts, pump or other equipment failure, loss of pump or other equipment down well due to pipe or wire breakage, well collapse due to removal of pump, pipe, wire or well casing. Certain conditions may require contracting of additional services (with GeoWater or third parties) to remediate impacts above. In rare circumstances, complete well loss can occur, requiring well replacement.

Estimates

Estimates are prepared using professional judgment as to time and materials needed to complete any project.
Customer acknowledges that in many cases, estimates are prepared based upon unknown site or project conditions.
This is especially true for “down hole” conditions. (I.E: structural integrity down the well, pump, motor, pipe and wire or other material conditions.) Estimates are subject to change based upon new or unknown site conditions.

Post Repair Conditions

For many well repairs, GeoWater is required by law to disinfect the well and equipment by chlorination. Customer acknowledges responsibility for limiting domestic consumption, laundry, & bathing until the chlorine has been removed or dissipated. Many well repairs may temporarily increase sediments from the well or well equipment and may impact house systems (filters, plumbing screens, etc.) Customer acknowledges that any subsequent cleaning and / or repairs are the responsibility of the Customer.

By signing below, Customer authorizes GeoWater to attempt well repairs at the address referenced below and acknowledges that GeoWater is not responsible for any site conditions which may cause any well or well equipment failure, including but not limited to: well collapse due to removal of pump, pipe, wire or well casing, loss of pump or other equipment due to pipe breakage, pump or other equipment failure, landscape damage, post-repair impacts, or any damage caused by attempts at repairs. Upon engagement of GeoWater to perform any services, Customer agrees to release GeoWater from any liability related to such services, and indemnify and hold harmless GeoWater from any claims related to such services.