WATER RESOURCES AUTHORITY
Conservation Fixture Request
this form, fill it out and return by regular mail or fax to :
Elaine Donahue, MWRA Operations Planning, 100 First Avenue, Boston, MA 02129
Fax: 617 788-4888
Phone (h): (___)___________
QuincyReading*RevereSaugus Southborough South Hadley FD #1SomervilleStonehamSwampscott WalpoleWalthamWatertownWakefield*Wellesley*Weston Westwood*WilbrahamWinchester*WinthropWoburn*Worcester
Are you the owner?
_____ If no, please provide the following information:
have owner approval)
List each property
and apartment sequence separately and complete information below:
Number of: Living
How Many? Bathrooms:
____; Toilets: *_____; Showers: _____; Kitchens: _____
* Do you have a low-flow (1.6 gallon per flush) toilet(s)? ____yes _____no
Please be advised that toilet dams should not be used on low-flow toilets (installed after 1989).
Why do you want
to install water saving fixtures? (check all that apply)
How did you learn
about this service?
I certify that
the above information is true. I will install the fixtures provided in a timely
manner. I give the MWRA permission to verify that the fixtures have been installed.