The SEMIZENTRAL approach has been developed for fast growing cities, to meet their challenges regarding the supply of water and the treatment of biowaste and wastewater. Key elements of the SEMIZENTRAL integrated infrastructure approach are high resource efficiency due to urban water reuse and the usage of the energy potential of wastewater/sludge and waste, as well as its system size between central and decentral. In Qingdao (PR China), the SEMIZENTRAL Resource Recovery Center (RRC) has been implemented for the first time worldwide at full scale. The goal of high resource efficiency, which includes generating service water, has a significant influence on the process design of the RRC. Moreover, the influence of the site adaptation of the general SEMIZENTRAL approach to the actual location in Qingdao on emissions to the water body and on the energy balance has been investigated. Through comparisons with a conventional wastewater treatment plant, advantages and disadvantages are evaluated. Due to water reuse, energy can be saved, compared to alternative water resources. The discharged nutrient load decreases considerably. Nevertheless, the effort required for wastewater treatment increases.