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B. Other Wastewater Flow (in addition to Fixture Units identified in Section A) Type of Facility/Process: Estimated Wastewater Discharge: Gallons/days Residential Customer Equivalents (RCE): 187 gallons per day equals 1.0 RCE Total Discharge (gal/day) 187 = RCE A. Fixture Units Fixture Units x Number of Fixtures = Total Fixture Units Fixture Units No. of Fixtures Total Kind of Fixture Public Private Public Private Fixture Units Bathtub and Shower 4 4 Shower, per head 2 2 Dishwasher 2 2 Drinking fountain (each head) 1 0.5 Hose bibb (interior) 2.5 2.5 Clothes washer or laundry tub 4 2 Sink, bar or lavatory 2 1 Sink, Clinic flushing 8 8 Sink, kitchen 3 2 Sink, other (service) 3 1.5 Sink, wash fountain, circle spray 4 3 Urinal, flush valve, 1 GPF 5 2 Urinal, flush valve, >1 GPF 6 2 Water closet, tank or valve, 1.6 GPF 6 3 Water closet, tank or valve, >1.6 GPF 8 4 Residential Customer Equivalent (RCE) 20 fixture units equal 1.0 RCE Total Fixture Units Total Fixture Units 20 = RCE To be completed for all new sewer connections, reconnections or change of use of existing connections. Please Print or Type C. Total Residential Customer Equivalents: (add A & B) A + B = Total RCE For King County Use Only Account No. of RCEs Rate Department of Natural Resources and Parks Wastewater Treatment Division 2008_10273w_nonres_sewer_cap_chg_1058.indd (Rev. 8/20) Alternative Housing Sewer Use Certification Sewage Treatment Capacity Charge Pursuant to King County Code 28.84.050, all sewer customers who establish a new service which uses metropolitan sewage facilities shall be subject to a capacity charge. The amount of the charge is established annually by the Metropolitan King County Council at a rate per month, per residential customer or residential customer equivalent, for a period of fifteen years. The purpose of the charge is to recover costs of providing sewage treatment capacity for new sewer customers. All future billings can be prepaid at a discounted amount. Questions regarding the capacity charge or this form should be referred to King County’s Wastewater Treatment Division at [PHONE REDACTED]. I understand that the information given is correct. I understand that the capacity charge levied will be based on this information. I understand that any deviation may result in a revised capacity charge. Signature of Owner/Representative Date Print Name of City State ZIP Owner’s Name Owner’s Mailing Address City State ZIP Owner’s Phone Number including Area Code Property Contact Phone Number including Area Code Party to be Billed (if different from owner) Address City State ZIP Type of property (Check one): Adult Family Home Student Dormitory Demolition of pre-existing structure? Yes No Was structure on sanitary sewer? Yes No Was sewer connected before 2/1/90? Yes No Sewer disconnection date: Type of structure demolished: Address of demolished structure: Demolition or capping permit number: Are multiple structures replacing the demolished structure? Yes No MicroHousing Property Street Address Property Tax ID Subdivision Name: Lot Subdiv. Block Building Name (if applicable): City or Sewer District: Sewer or Building Permit Final Date: Side Sewer or Building Permit Number: Please report any demolitions of pre-existing structures on this property and include a copy of the permit. Credit for a demolition may be given under some circumstances. (See King County Code 28.84.050, O.5) WA SIGN