Request for Sewer Fee Adjustment

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PURPOSE:  Information provided on this form will be used to adjust sewer service fees for water consumption that is not disposed of through the Town’s wastewater collection and treatment system. Fees are based on 90 percent (for single-family residence) of water consumption billed during three (3) 28- to 35-day billing cycles during the winter months. This could include water consumption during a portion or all of November, December, January, and February depending on when your water meter is read. If you planted a winter lawn or garden, filled a swimming pool or experienced a leak, you may have a qualifying event. If you believe you have a qualifying event and would like your sewer charges reviewed for possible adjustment, please provide the following information:

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Name
 *
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Account Number
 *
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Service Address
 *
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Subdivision
5
Home Phone
 *
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Alternate Number
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November through March, please estimate the following for your property (if applicable):
November through March, please estimate the following for your property (if applicable):
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The above information is true and accurate to the best of my knowledge.  I understand that the given values are subject to verification and if there are errors, I will be charged for any incorrect allowance not previously billed.

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The above information is true and accurate to the best of my knowledge. I understand that the given values are subject to verification and if there are errors, I will be charged for any incorrect allowance not previously billed.

Allowances based on the information provided will be reflected in future bills. Rate adjustments will not be made for the months prior to the date this form was mailed. Customers are required to resubmit appeals each year when the wastewater fees are recalculated. If you have any questions about this form, please call 480-358-3455.

Completed sewer adjustment requests must be received by the Utility Services Department within 90 days of receipt of the first bill that indicates the new service fee to qualify for a sewer rate adjustment. Mail the completed form (and any attachments) to:

Town of Queen Creek, Attn: Water Division / Connie Speelman, 22358 S. Ellsworth Road, Queen Creek, AZ 85142 or fax to 480-358-3001 or scan and e-mail to Connie.Speelman@QueenCreek.org.

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