Refund Request—Excess Water Use Surcharge

Please enter an input in every field, even if it is zero.

REFUND POLICY:  If a municipality refunds to its customer all or part of the cost of water lost due to a customer-side leak, that customer is also eligible to have applicable Excess Water Use Surcharge (EWUS) refunded for the same volume of water.  For example, if a city refunds half of the consumption attributable to a leak, the city may also refund the EWUS incurred on the same volume of water.

  • If the city did not make a financial accommodation for a customer side leak, that customer is not eligible for a refund of EWUS.
  • Refunds of EWUS only occur through a municipality. The district does not negotiate EWUS directly with customers served by the municipality.
  • The municipality must refund the EWUS directly to the affected customer, then complete this form to be reimbursed by the district. 
  • By submitting this form, you attest the city has already refunded both municipal water revenue and associated EWUS to a customer that has incurred a leak.

    Credit requested by:




    Period to apply credit:



    Tier 1 Surcharges ?
    Pre 2023 Connections

    Tier 2 Surcharges ?
    Post 2023 Connections

    Totals

    # of meters

    Excess volume (KGAL)

    Revenue ($1/KGAL)

    # of meters

    Excess volume (KGAL)

    Revenue ($10/KGAL)

    Total cost

    3/4" meters

    $0.00

    $0.00

    $0.00

    1" meters

    $0.00

    $0.00

    $0.00

    1 1/2" meters

    $0.00

    $0.00

    $0.00

    2" meters

    $0.00

    $0.00

    $0.00

    3" meters

    $0.00

    $0.00

    $0.00

    4" meters

    $0.00

    $0.00

    $0.00

    6" meters

    $0.00

    $0.00

    $0.00

    Other

    $0.00

    $0.00

    $0.00

    Totals

    0

    0

    $0.00

    0

    0

    $0.00

    $0.00

    Administrative fee already retained by agency

    $0.00

    Municipal refund amount

    $0.00