LEAK ADJUSTMENT FORMi
CITY OF EDMONDS
MIKE NELSON
CITY HALL • FIRST FLOOR MAYOR
EDMONDS, WA 98020 • (425)771-0240 • FAX (425)771-0265
FINANCE AND INFORMATION SYSTEMS DEPARTMENT
CITY OF EDMONDS
LEAK ADJUSTMENT POLICY
(Revised 02/2013)
Leak adjustments are NOT available for leaks occurring within a residential or commercial structure
where the amount of the adjustment would have otherwise been less than $50 per billing. Also,
adjustments are only available in instances where water consumption is more than 20% greater than the
same period in the previous three years.
1. To qualify for a leak adjustment the:
a) Customer must satisfactorily demonstrate a leak was undetected and caused by unusual
circumstances beyond the customer's control; and
b) Must take action to repair a leak within thirty 30 days of when the customer discovers or is
notified of a leak; and
c) Complete and submit a City application form within 90 days of the repair accompanied by a
copy of the finalized water service line permit to the City Finance Department, Edmonds City
Hall, 121 50, Avenue North, Edmonds, WA 98020. If the repair is exempt from permit, a
signature is required from the City of Edmonds Development Services Department indicating
a permit is not required.
2. Only one leak adjustment will be granted in any three year period; and will be limited to the
equivalent of three billing cycles.
3. Adjustments exceeding $500 require approval by the Finance Director.
4. A leak adjustment credit shall be determined as follows:
a. The average consumption for the same period during the previous three years, charged at
the City's retail rate, plus the excess water loss from the leak charged at the City's
wholesale rate. An additional 15% administrative cost is applied to the excess loss only.
b. If the adjustment is for a commercial account that is billed for sewer service based on water
consumption, the City will also adjust the sewer portion based on the same calculations
less administrative costs.
5. Adjustments are limited to $1,000 per leak for both residential and commercial customers.
City of Edmonds CZ Finance and Information Systems
i l
CITE' OF EDMONDS
121 5T" AVENUE NORTH . EDMONDS, WA 98020
(425)771-0241 • FAX (425)771-0265
FINANCE AND INFORMATION SERVICES DEPARTMENT
The City of Edmonds offers a leak adjustment on customer bills for qualifying water leaks.
To qualify for an adjustment you must:
• Not have received a previous adjustment in the past three years.
MIKE NELSON
MAYOR
• Have satisfactorily demonstrated a leak was undetected and caused by unusual circumstances
beyond control. Indoor plumbing, appliances, hose bib, pool, water features, theft or vandalism
do not qualify.
• Have taken action to repair the leak within 30 -days of when the leak was discovered or within 30
days of being notified.
* Provide proof of repair within 90 days of the repair accompanied by a copy of the finalized water
service line permit. If the repair is exempt from permit, a signature is required from the City of
Edmonds Development Services Department indicating a permit is not required. For more
information, please call 425-771-0220.
If you determine you qualify and wish to apply for a Leak Adjustment, please complete this form and
return it to our office as soon as possible with the necessary receipts. NO ACTION CAN BE TAKEN
TO PROCESS YOUR ADJUSTMENT UNTIL INFORMATION ON THE COMPLETED
APPLICATION FORM IS RECEIVED.
APPLICATION FOR LEAK ADJUSTMENT CREDIT
Name: Robert J. Welenofsky
Service Address:
City:
Mailing Address:
City:
Daytime Phone:
8024 181st Place SW
Edmonds State: W A
P 0 B-o-x -1'ZS5
Lynnwood
425-314-5420:
Date: March 28, 2021
Zip Code: 98026
State: W A Zip Code: 98046
Account Number: 3 24950
Edmonds Public R-orks Dept
Date* first noticed your leak: 3 / 16 / 2 0 21 Date the leak was repaired: March 25, 2021
Where was the leak located? (Please indicate below)
0 Inside the house M Between the house and the water meter F7 In the irrigation system
Are you a tenant at this property? ONO DYES - Landlord's Name,
Landlord's mailing address:
City State Zip Code: Daytime Phone:
Please describe how your leak was identified or provide any additional facts you think might be helpful
below: (or attach an extra page): o u r
When my wife Marilyn and I arrived home from.&& two -week
vacation to Hawaii on March 20, 2021, we saw a notice on our front
door that we h.ad excessive water usage from March. 8, 2021.
P saw that the water meter was sp nning'around and turned off
the water valve to stop the flow. "2 Sons Plumbing" repaired
the leak.. on '-*Mar.ch-_ 28, 20.2.1.
By signing this request, I certify that I understand the terms and conditions of the City of Edmonds
Leak Adjustment Policy and acknowledge that I will not be eligible for an additional Leak
Adjustment in the next three year period.
Customer Signature: Date: 3 Z
Note:
• If you haven't received a bill through the date your leak was repaired, we will process your
claim after your next bill.
• If you have received a bill and your claim has not been processed, we suggest that you pay the
amount due by the due date to avoid delinquent charges. The adjustment will be applied to
your next bill.
• This form does not relieve responsibility of payment. If approved, the City will only adjust up
to three billing cycles.
CITY OF EDMONDS USE ONLY
Permit Exemption Approved By:
Date: