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3rd Party Land Permission Form

Please complete the details below and submit the form using the green button. Once you've given us permission to access to the land, we'll get the work scheduled.

Leak on Private Supply Pipe - 3rd Party Land Permission Proforma

Unfortunately there is a leak on the private water supply pipe that runs through your land that feeds a different property to your own. In order to get the leak repaired we will need you to permit us to work on your land. There are no costs involved for you as the customer as this is a free of charge service we are providing.

Severn Trent Water will need to excavate on your land, where reasonably possible we will try to reinstate this to the original condition it was in prior to the excavation.

Please note that as this is a private issue for which Severn Trent Water are not responsible and have stepped in as a way to resolve the issue and to stop water from wasting.

For all customers, leaks can cause damage to gardens and property and we have an obligation under the Water Industry Act 1991 to ensure water is not wasted.

If you would like to be present when we repair the leak we can arrange an appointment with you, please tick the below boxes to confirm you understand and accept the terms mentioned above.

Please note, any alteration to this document renders this contract null and void.

By filling out and signing the below boxes you are agreeing to the conditions mentioned above and will allow Severn Trent Water to access your land to carry out the necessary works.

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The asterisk (*) symbol denotes required fields.

The below information should be completed by the property owner only

Order Number of leak

Please enter a valid order number of leak

First Name *

Please enter a valid first name

Last Name *

Please enter a valid last name

Preferred contact number *

Please enter a valid preferred contact number

Email address

Please enter a valid email address

The below should relate to the address connected with the leak

Tell us the address where the leak is:

Postcode of where leak is *

Enter a postcode

Enter a valid postcode

Enter a postcode and select 'Find address'

I would like an appointment to be arranged so I am present when the works take place. *

Please select a title

Please agree to our terms and conditions