Rural Water and Sewer Servicing (RWSS) Service Connection Application Form

All mandatory fields denoted by an * must be filled in.
being the registered property owner(s) of the residential property located at:

I confirm the following as part of our request to participate in the RWSS program:

1) I am (one of) the legal owner(s) of the property and voluntarily wish to participate in the RWSS Service Connection Program.

2) The property is a residential property described as and as defined in the Land Use Bylaw No. 99/059:*

Single Detached 
Manufactured Home 
Modular Home 
Other (Describe below) 

*The Application Committee will review to confirm the description of the dwelling and will confirm the land zoning when considering the complete Application.

3) Concurrent with this Application, I am paying the application fee for the Service Connection of $200.00 (Two Hundred Dollars). I understand that there is a balance due for the Service Connection Fee and elect to pay it as follows:

Lump Sum - onetime payment of $15,800.00 for Anzac, Conklin, Draper, Gregoire Lake Estates and Janvier and onetime payment of $9,800.00 for Saprae Creek Estates at the time the service connection is completed, after the inspection and completion report is issued by Safety Codes; or

Installment Payments - every two (2) months starting at the time the service connection is completed, after the inspection and completion report is issued by Safety Codes for the next 25 years as per Schedule B to Bylaw 20/009 Rural Area Water and Wastewater Service Connection Bylaw (the “Bylaw”).

4) I understand that any unpaid portion of the Service Connection fee will be rolled over to the property tax bill for the subject property, including all applicable interest.

5) I will be responsible to hire a Certified Contractor to design and install the Service Connection to be located on my property. A list of Certified Contractors is available on the Government of Alberta website, is maintained by Alberta Municipal Affairs and is called the “Private Sewage Systems Installer Certification List”.

6) I will be responsible to sign a contract to hire a Certified Contractor from the Private Sewage Systems Installer Certification List and to ensure that all fees pertaining to design, permits, construction and warranties for the Service Connection are included within the contract with the Certified Contractor.

7) So long as I comply with the above requirements, I understand that the RMWB will pay the costs of the installation of the Service Connection(s) directly to the Certified Contractor and the Owner(s) will pay the Service Connection Fee to the RMWB as described herein and in the Bylaw.

8) I further confirm that the RMWB is not liable for the Service Connection or the work performed by the Certified Contractor nor the future maintenance or repair costs for the service connection.

9) I understand that pursuant to the Bylaw, the Application Committee will consider my Application, when complete, to assess the qualification of the Owner(s) and eligibility of the property for participation in the Funding Program and may reject quotes or proposed contracts with the Certified Contractor.

Billing Address (As it appears on your credit card)