Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Water Leak Adjustment Form


  1. 1. Acknowledgment of Terms
  2. 2. Request for Leak Adjustment
  • Acknowledgment of Terms

    1. Please read before submitting form:
      This form is only applicable to leaks that have been determined to be an "excusable defect," per the City's Code of Ordinances.
    2. "As used in this section, the term “excusable defect” shall mean a rupture or leakage of the customer’s underground water lines from the meter to the foundation and/or under the foundation as may be caused by freezing weather, settlement, corrosion, wear or accident. The term does not include or apply to defective or out-of-repair faucets (inside or outside), internal wall plumbing, sprinkler systems, sprinkler heads, sprinkler lines, sprinkler solenoids, swimming pools, auto-fill pool equipment, toilets, toilet flappers and any outdoor fixture/accessory such as an outdoor kitchen." - City of Melissa, Ordinance No. #20-04
    3. I have read the above Ordinance and believe I qualify for a leak adjustment.*