PUMPOUT
PROGRAM REGISTRATION FORM
* indicates required field
Danvers Harbor pump out services are brought
to you under the federal Clean Vessel Act (CVA). The Clean Vessel
Act was
passed by Congress
in 1992 and established a federal grant program administered by the
U.S. Fish & Wildlife Service. Federal funds constitute 75% of
all equipment and operating costs for this service. Remaining costs
are funded locally by the Town of Danvers with boat excise tax receipts.
All pump out services are provided free of charge to recreational
boaters using Danvers Waterways. |
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LOCATION |
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*Vessel
Location:
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*Slip/Mooring
#:
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OWNER
INFORMATION |
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| *Last
Name: |
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| *First
Name: |
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| *Address: |
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| *City/Town: |
*State:
*Zip:
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| *Phone: |
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*E-Mail:
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VESSEL
INFORMATION |
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| *Reg./Doc.
#: |
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| *Vessel
Name: |
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| *Make: |
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| *Model: |
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| *Length: |
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| *Primary Waste Cap Location: |
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| Secondary
Waste Cap Location: |
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| *Holding
Tank Size (Gallons): |
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WAIVER
& RELEASE |
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I as owner
of the above listed vessel have requested that the Town of Danvers
pump out the holding tank(s) of my vessel while I am not aboard.
I realize that participating in the Town of Danvers pump out program
requires that the pump out vessel must come in close contact with
my vessel, and that the Town of Danvers and its pump out vessel
operator(s) take reasonable precaution to avoid damaging my vessel
during their operations. I also realize that despite the efforts
of the pump out operator(s), such close contact between vessels
can occasionally result in minor cosmetic or mechanical damage
or loss to my vessel. By engaging the Town of Danvers pump out
program, I understand and agree that the Town of Danvers, its officers,
employees, volunteers, contributors, partners and vessels, are
not responsible for any such damages or losses that may occur as
a result of participating in the pump out program, and I hereby
waive my right to claim any such responsibility or liability, in
a court of law or admiralty or otherwise, for any such damages
against Town of Danvers, its officers, employees, volunteers, contributors,
partners or vessels.
By placing a piece of tape over the pump-out deck fitting, I
represent to the Town of Danvers that the vent is in working
order, the valves are in their proper position for pump out and
that I have advised the marina that the vessel will be serviced
in my absence. In consideration of the pump out service provided
by the Town of Danvers without charge, I waive and release any
claims against the Town of Danvers for damage to the vessel or
its systems arising in connection with the provision by the Town
of Danvers of the pump-out service.
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*
I am either the owner (or authorized by the owner{s}) to request
these services,
and I agree to the damage waiver above.
(Check in box required
to participate in pump out program)
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*Please
pump out my vessel: |
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