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Appliance and Fixture Count Form 2020

This document is a fixture worksheet for a private water system. It collects information about the types of uses served by the water meter, including residential, irrigation, and fire protection. It also lists the number and types of existing and new fixtures, such as sinks, showers, and outdoor hoses. The total fixture units are calculated and used to determine the required flow rate, velocity, meter size, and service line size based on the project's water needs.

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Mohsin Shaikh
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© © All Rights Reserved
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56 views2 pages

Appliance and Fixture Count Form 2020

This document is a fixture worksheet for a private water system. It collects information about the types of uses served by the water meter, including residential, irrigation, and fire protection. It also lists the number and types of existing and new fixtures, such as sinks, showers, and outdoor hoses. The total fixture units are calculated and used to determine the required flow rate, velocity, meter size, and service line size based on the project's water needs.

Uploaded by

Mohsin Shaikh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PRIVATE WATER SYSTEM FIXTURE WORKSHEET

Date:

Owner Name: Phone Number:


Service Address:
Mailing Address:
Email Address:
Assessor Parcel Number (APN):

Types of use to be served by the meter (Select all that apply):

Single Family Residential Landscape Irrigation Fire Protection System


Accessory Dwelling Unit (ADU) Agriculture Irrigation Other:
Multiple-Family Residential Commercial

Brief Project Description / Reason for Review

Number of Number of
Total FINAL UPC/GWD Units per
Appliance / Fixture Type EXISTING NEW
Fixture Units Fixture
Fixtures Fixtures
Kitchen(s)
Dishwasher 0.00 1.5
Kitchen Sink 0.00 1.5
Refrigerator Water Maker 0.00 0.5
Refrigerator Ice Maker 0.00 0.5
Other: 0.00 0
Laundry Room(s) 0
Clothes Washer 0.00 4.0
Laundry Sink 0.00 1.5
Other: 0.00 0
Bathroom(s) 0
Bathtub 0.00 4.0
Combination Bath / Shower 0.00 4.0
Shower 0.00 2.0
Toilet 0.00 2.5
Bathroom Sink 0.00 1.0
Bidet 0.00 1.0
Other: 0.00 0
Other Rooms 0
Wet-bar sink 0.00 1.0
Other: 0.00 0
Other: 0.00 0
Other: 0.00 0
Outdoor Fixtures 0
Primary Hose Bib (Max 1 total) 0.00 2.5
Hose Bibs – additional
0.00 1.0
(# more than Primary above)
Fixture Summary Worksheet Page 2 of 2

Swimming Pool* 1.0


SF SF 0.00
Approximate total square footage per 100 SF
Spa / HotTub / Jacuzzi 1.0
SF SF 0.00
Approximate total square footage per 100 SF
Fountain 0.00 1.0
Lawn Sprinklers
(Total Number of heads for largest
0.00 1.0
station or set of stations run
together)
Drip Irrigation System**
1.0
(Approximate Square Footage of SF SF 0.00
per 100 SF
Yards Combined)
Fire Sprinkler System *** 0.00 GPM
0
Added Below
Other: 0.00 0
Total Fixture Units 0.00

+ 0.00 GPM will be added to the fire flow rate for the purposes of sizing meters and service lines.

Notes
*For pools, spas, fountains, etc., only include them if they are equipped with an auto-topper. Do not include if filled manually from a
hose bib already counted.

**For irrigation systems, only include if separately plumbed. Do not include if connected directly to a hose bib already counted or
manually watered.

***Separate Fire Sprinkler Calculations Prepared by an engineer or fire protection specialist are also required

For Internal Goleta Water District Use

GWD Project Manager

GWD Property # Existing Meter Size: Existing Service Line Size

Fixture Unit Flow Rate Total gpm Flow Velocity fps


Based on Table above

Fire Protection System Flow Rate gpm Flow Velocity fps


Based on Engineer’s Fire Calculations

Meter Size Change Required: No or Yes, Size Required:

Service Line Change Required: No or Yes, Size Required:

Notes:

Engineering Analysis Approved by: Date:

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