The NYC DEP Backflow Prevention Form serves as a crucial document for property owners in New York City who are required by law to install backflow prevention devices to safeguard the city's water supply from contamination. These devices prevent the reverse flow of water from a property back into the public water system, thereby ensuring the purity and safety of the water. The guidelines and steps outlined in the Department of Environmental Protection's instructions provide a comprehensive roadmap for the preparation, submission, and approval of plans for the installation of these devices, emphasizing the importance of compliance for property owners.
Understanding the nuances of the New York City Department of Environmental Protection (DEP) Backflow Prevention Form is crucial for property owners, professionals in the engineering and architectural fields, and plumbing specialists. This document, a supplement to the New York State Department of Health's Handbook for Cross Connection Control, outlines the necessary steps and requirements for the prevention of water supply contamination through backflow. It highlights the mandated installation of backflow prevention devices for properties that could pose a risk to the city's water system, detailing the intricacies of compliance—from planning and plan submission to the installation and annual testing of these devices. Emphasizing the importance of professional input, the text specifies that plans must be developed by a Professional Engineer (PE) or Registered Portfolio (RA) and installed by a licensed master plumber, following strict guidelines and approval processes managed by the DEP. Additionally, it underscores the prohibition of certain practices, such as the use of unauthorized connections and the specific architectural requirements to accommodate these vital safety devices. Moreover, the form outlines the conditions under which exemptions might be requested and granted, but leaves no room for aesthetic considerations to compromise water safety. This comprehensive approach serves not only to protect public health but also to guide property owners and professionals through the regulatory environment surrounding backflow prevention in New York City.
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WATER & SEWER OPERATIONS
REVISED SUPPLEMENT TO THE NEW YORK STATE DEPARTMENT OF HEALTH HANDBOOK FOR CROSS CONNECTION CONTROL
This supplement was last revised on (6/10)
Introductory Note:
This supplement will help you prepare backflow prevention plans for submittal. It is a guide only and should not be used as a substitute for experience in the planning and design of backflow prevention device installations. If you are not experienced with this type of work, we suggest that you consult with a professional.
To avoid the expense and delay necessitated by the removal and reinstallation of containment devices, we suggest that you have your plans approved by DEP before proceeding with installation.
For new facilities, aesthetic considerations and architectural design is an unacceptable reason for granting exemptions. The architectural design must accommodate the containment devices, not the other way around.
Please note that the filing Professional Engineer or Registered Architect is expected to review the potential for hazard posed by the occupancy of the premises.
Based upon this review, the filing Professional Engineer or Registered Architect should select an appropriate containment device in accordance with the latest revision of the DEP Cross Connection Control Risk Assessment.
Page 1
Rev. 06/10
OVERVIEW OF THE NYC ENVIRONMENTAL PROTECTION
CROSS-CONNECTION CONTROL PROGRAM
For the Protection of the Water Supply System by Containment
WHO IS AFFECTED
Owners of properties that pose an actual or potential risk of contamination to New York City’s water supply. This includes property with any of, but not limited to, the following facilities:
BAKERY
AUTO BODY / REPAIR SHOPS
BIDETS
BEAUTY SALONS OR BARBER SHOPS
CAR WASH
BUTCHERS (INCLUDES FISH MARKETS & LIVE STOCK)
CHEMICALS USED IN PROCESSING e.g.
CHEMICALLY TREATED BOILERS
DYE PLANTS, PHOTO LABORATORIES
COMMERCIAL LAUNDRY FACILITIES WITH 2 OR MORE COIN
DRY-CLEANING ESTABLISHMENTS
OPERATED MACHINES
DELICATESSEN /PREMISES WHERE FOOD IS BEING PREPARED
COMMERCIAL KITCHENS / RESTAURANTS
DENTAL OFFICES /LABORATORIES
LARGE BOILERS (MORE THAN 350000 BTU)
DISTILLED BREWERIES
BOOSTER PUMPS
FUNERAL PARLORS
HOTELS AND/OR MOTELS
GREENHOUSES
GAS STATIONS AND/OR MINI MARTS WITH SODA MACHINES OR
COFFEE LINES
IN-GROUND IRRIGATION SPRINKLER
HEAT EXCHANGERS WITH WATER (SINGLE WALL)
WELLS (GROUNDWATER)
PHARMACY
MULTIPLE WATER SERVICES
PRESSURE TANKS
SEWAGE TREATMENT OR HANDLING
PRIVATE WELLS
VETERINARY OFFICES / LABORATORIES
SWIMMING POOLS / COMMERCIAL SWIMMING POOLS
WAREHOUSES (WITH TOXIC CHEMICALS STORAGE)
METAL MANUFACTURING, CLEANING, PROCESSING OR
FABRICATING PLANTS
WATER REUSE / RECYCLING
WATER COOLED EQUIPMENT OR CHILLERS
MEDICAL OFFICES / LABORATORIES
WATER STORAGE TANKS
(INCLUDES PSYCHOLOGY & PSYCHIATRIC OFFICES THAT
ADMINISTER MEDICATION)
WHAT LAW REQUIRES
Owners must install special plumbing devices, known as a backflow prevention device(s) on the water service pipes that supply their property. The device prevents water from flowing back into the City’s drinking water supply. Owners must obtain the approval of plans submitted to the Department of Environmental Protection (DEP) before installing the device and have the device tested by a state certified backflow-prevention device tester at least once a year. DEP’s Bureau of Water and Sewer Operations is charged with enforcing Part 5 Section 5-1.31 of the State Sanitary Code and Title 15, Chapter 20 of the Rules of the City of New York (RCNY).
HOW TO COMPLY
Step 1: A Professional Engineer (PE) or Registered Architect (RA) must prepare and submit two sets of plans and two applications originals (form GEN-236 New York City Version) for the installation of Backflow Prevention Device(s) to the Bureau of Water and Sewer Operations, Division of Permitting and Inspections for approval. All submissions must have original ink signatures and original ink or impression seals. Plans and applications must be corrected and resubmitted as necessary until acceptable.
Step 2: When the plans are approved, the Division of Permitting and Inspections issues a plan approval letter to the customer and returns one copy of the approved plans to the PE or RA of record.
Step 3: The device(s) must be:
Installed by a New York City Licensed Master Plumber in accordance with the approved plans (installations must also meet the Building Department’s and the Bureau of Customer Service’s requirements).
Tested by a State Certified Backflow Prevention Device Tester who is either a Licensed Master Plumber or employed by one. Inspected by a PE or RA and certified that they have found the installation to be in accordance with the approved plans.
Step 4: Finally, a completed “Report on Test and Maintenance of Backflow Prevention Device” (form GEN-215B), certifying the job, must be submitted to DEP within thirty days of installation of the device.
Step 5: Annual Inspection: At least once a year, the device must be inspected, maintained and tested, by a state certified tester. The results of the test must be reported to the department by filing Form GEN 215B with parts A & B properly completed.
Note: Be aware that some plumbers may provide “Turn Key” installation.
Page 2
If you believe that your premise does not require a Backflow Prevention Device, you may have a Professional Engineer, Registered Architect, or Licensed Master Plumber submit a request for Exemption to the DEP Cross Connection Control Unit for consideration. If approved an exemption letter will be issued.
Steps for Installing Backflow Prevention Device
The following steps must be taken for the preparation, submission and approval of plans and the installation of backflow prevention devices for CONTAINMENT of facilities:
Step 1: A Professional Engineer (PE) or Registered Architect (RA) must prepare and submit two sets of plans and two applications originals (form GEN 236 New York City Version) for the installation of Backflow Prevention Device to the Bureau of Water and Sewer Operations, Division of Permitting and Connections for approval. All submissions must have original ink signatures and original ink or impression seals. Plans and applications must be corrected and resubmitted as necessary until acceptable.
Step 2: When the plans are approved, the Division of Permitting and Connections issues a plan approval letter to the customer and returns one copy of the approved plans to the PE or RA of record.
Step 3: Device(s) must be:
•
Installed by a New York City Licensed Master Plumber in accordance with the approved
plans (installations must also meet the Building Department’s and the Bureau of Customer
Service’s requirements)
Tested by a State certified Backflow Prevention Device Tester who is either a Licensed
Master Plumber or employed by one
Inspected by a PE or RA and certified that they have found the installation to be in
accordance with the approved plans.
Step 4:
Submit the “Report on Test Maintenance of Backflow Prevention Device” (Form GEN
215B), certifying the job to DEP within thirty days of device installation.
DEP will refer improper installations to the owner, PE or RA, or both. Improper installations must be corrected and re-certified (with Form GEN 215B) until acceptable. All installations are subject to inspection and verification.
Page 3
Guidelines for Filling out Proposal of Backflow Prevention Device(s) Installation
General:
Provide two sets of plans and two GEN 236 application forms bearing the original signature and seal of the applicant.
All services of the same facility shall be protected and listed on the application.
Backflow Prevention (BFP) Device(s) shall be NYS – DOH approved.
No strainers are allowed between the water meter and the device. If required, strainer shall be approved type installed on the street side of the meter.
No take offs are allowed on the street side of the device except approved combined services.
Piping to be unbranched and unrestricted from main to device except for meter.
The device shall be installed between the meter and the meter test tee.
Meter test tee shall be capped or plugged.
For RPZ and RPD devices where the proposed installation has to be below grade (i.e. Cellar or Basement), the applicant shall provide time calculations for full device failure up to the submersion of device discharge port. The time shall exceed 8 hours; otherwise, device(s) shall be installed above grade.
Need to provide Elevation Plan, Floor Plan, Plot Plan, Engineering Report and notes.
Floor Plan
Show a minimum of 30 in. clearance from the side of the device to the farthest wall or obstruction.
Show a minimum of 8 in. clearance from the side of the device to the closest wall or obstruction.
Show size of the meter.
Plan view showing every BFP in conjunction with the water meter, test tee, meter inlet control valve (MICV) and meter outlet control valve (MOCV).
Drainage details for RPZ’s must be shown.
Elevation Plan:
Provide a minimum of 30 in. clearance space from the centerline of device to floor.
Provide a maximum of 60 in. clearance space from the centerline of device to floor.
Provide a minimum clearance of 12 in. from the device to the ceiling.
Air gap between the RPZ’s relief port and the drain must be:
2 in. air gap for device size of ¾ in. to 1 in.
3 in. air gap for device size of 1 ¼ in. to 1 ½ in. 4 in. air gap for device of 2 in. or larger
If there is no gravity drainage, device shall be installed above grade. Sump Pump is not acceptable for gravity drainage.
Plot Plan:
Show north arrow
Show the size of water service
Site plan for the entire facility must show the closed property line and labeling or all water service lines, mains, streets, location of BFP.
Notes:
Print the drainage area in sq. ft. if you are installing in the basement or the cellar.
If the BFP is installed more than 60 in. from the centerline above the floor, an OSHA approved platform, scaffold or ladder must be provided for maintenance and testing.
Between point of entry and BFP, the pipes must be stenciled “FEED TO BACKFLOW PREVENTER, DO NOT TAP OR CONNECT TO THIS LINE.” at 5 ft intervals, and at all wall and floor penetration
Page 4
APPLICATION FOR APPROVAL OF BACKFLOW PREVENTION DEVICES
[] FEE: $350 PER SERVICE CONNECTION
PRINT OR TYPE ALL ENTRIES EXCEPT SIGNATURES
0. Block #
0a. Lot #
FOR DEPARTMENT USE ONLY
Please complete items 0 through 13.
1.
Name of Facility:
2. County:
0b. Tentative Lot #
3.
Exact Location of Facility; i.e., Street Address:
3a.
City
3b.
State
3c. Zip
4. Contact Person:
4a.
Phone Number(s):
New York
5.
Location of Device(s): (Attach additional sheets if required)
6. Manufacturer,
Model No.
and Size of Device(s):
5a. # of Fire Services:
5b. # of Domestic Services:
5c. # of Combined Services:
5d. Total # of Services:
5e. Total # of Buildings:
7.
Name, Title & Phone No. of Property Owner:
8.
Type of Submission
[
]
As Built
Initial Device Installation
Full Mailing Address:
Replace Existing Device
8a.
] New Service
Existing Service
8b.
] New Building
] New Extension
] Major Renovation
Owner's Signature:
Date:
Existing Building
9.
Print Name and Address of Design Engineer or Architect:
10.
NYS License #:
] PE [ ] RA
[ ] Other
10a.
Telephone #:
10b.
FAX #:
10c.
Original Ink Signature & Seal Required on both copies.
11.
Water System Pressure (psi) at Point of Connection:
12. Estimated Installation cost:
10d.
EMAIL:
Max _________ Avg _________
Min _________
13.
Degree of Hazard:
List of Processes or reasons which lead to degree of hazard checked:
] Hazardous
] Non-Hazardous with Hazardous Fixtures
] Aesthetically Objectionable
14.
Public Water Supply Name:
NEW YORK CITY
Name of Supplier's Designated Representative:
Selim Andrawis, P.E.
Mailing Address:
NYC - DEP
Title:
Engineer-In-Charge
Bureau of Water & Sewer Operation
Cross-Connection Control Unit
The degree of hazard shown in (13) above is in corformity with the latest DEP
3rd Floor Low-Rise
Cross Connection Control Risk Assessment
59-17 Junction Boulevard
Flushing, NY 11373
Telephone No.: (718) 595-5463
Signature:*
Facsimile No.: (718) 595-5252
* Your signature endorses proposal
NOTE:
Two copies of this form and two copies of all plans, specifications and supporting materials must be submitted to:
New York City,
Department of Environmental Protection, Bureau of Water & Sewer Operations,
Cross-Connection Control Unit, 3rd Floor Low-Rise, 59-17 Junction Boulevard, Flushing, NY 11373.
Gen236 NYC version 3/11
INSTRUCTION FOR FORM GEN 236 (NYC VERSION)
0 to 4a) Fill in as appropriate. Be sure to include the block and lot numbers.
5)Be as specific as possible. (e.g. “8’ N of Elm Street and 12’ South of Main Street”)
5a, b, c) Fill in the number of services for the entire facility.
5d)
This is the total of 5 a, b, and c.
5e)
Fill in the total number of buildings in the facility. All adjacent buildings under the same
ownership, occupancy or operation are considered part of the facility. Distant buildings with the
same water, heating or other shared, common or interconnected systems are considered part of
the same facility. If you have doubts or uncertainties, feel free to elaborate at length on additional sheets.
6)Note Manufacturer, model & size of each device.
7)Indicate name, mailing address & phone number of property owner. Be sure this information is current. Failure to provide correct property owner mailing address will result in delayed notification.
Be sure to use original ink seal & signatures on both originals.
8, a, b) Check the applicable boxes
9)Print name & company (if any) of the design engineer or architect. (Do not use the name of the firm in place of the P.E.’s or R.A.’s name). Fill in the complete mailing address.
Be sure to use original ink seals & sign on both originals.
10)Include NYS License number in blank. Check appropriate category.
10 a, b) Be sure to enter all applicable phone/fax numbers.
10c)
Enter date application is signed.
11)Make sure that water system pressure at point of connection is included.
12)Be sure to include these estimates. No blanks permitted. Use fair market value if you are working for free.
13)Choose one of the Degree of Hazard and list the reasons. If you decided to choose Double Check Valve Assembly (DCVA), you are required to give the proper reasons.
14)To be completed by Water Supplier.
If you need additional space, use the back or attach additional sheets. If so, please indicate “Continued on back” or “See Additional Sheets” as appropriate.
Page 6
Cross Connection Control Unit
Review Form for BFP Plan
59-17 Junction Boulevard, 3Fl. Low Rise, Flushing, NY 11373-5108
To: ________________________________
Re:____________________________________
__________________________________________
Address: ___________________________________________
___________________________________________
Block:____________Lot:________________County: _________
* We are sending you: □Plans
□Samples
□Gen 236
□Other _____________________________
□DISAPPROVED
□RETURNED FOR ADDITIONAL INFORMATION
COMMENTS
□ 2 sets of plans & 2 copies of GEN 236 application forms required (Original)
□Drawings must be of acceptable standard quality & easily legible
□Require PE / RA’s signature and stamp/seal (original) on every Application Form (NYC, GEN236-# 9), every Plan and also the Engineering Report (if any)
□Need to provide Plot Plan (for the entire lot), Elev. Plan, Floor Plan, and Notes
□Provide Elaborated Eng. Report: Bldg. description, type of business, general use of water service(s) within facility, brief description water supply system, etc.
□Pipes to be disbranched & unrestricted from main to device except for meter.
□No strainers are allowed between Water Meter and BFP. If required, Strainer should be approved type (Flat Plate) and installed on street side of the Meter.
□No take offs are allowed on the street side of the BFP (although installation of BFP’s in parallel is allowed)
□Pipes not installed within 2 feet of device must be exposed and be readily accessible for inspection
□Need address of building on plan (every submitted drawing)
□Require labeling all items, (either existing or new) in the drawings
□Leave adequate space for NYC-DEP-CCCU approval stamps.
□ Show state (exist./new), size, type, single make, and model # of device on
plans
□Show state (existing/new) of all items on the drawings
□“RPZ” & “DCV” devices must be of the same size as the water meter or larger
□Show the clearances and direction of flow, on the Elevation and Plan views
□Every submitted drawing must have Block, Lot, & County indicated
□From point of entry inside the facility, House Control Valve should be installed within 2 feet, and Water Meter should be installed within 5 feet
□BFP must be installed between the Master Meter and Meter Test Tee
□Meter Test Tee, MICV and MOCV must be located near the water meter and installed within the same meter room with the HCV. MOCV must be installed on the HOUSE SIDE of test tee. 1.5” Test Tee is required for water meters 1.5” size or larger and it must be CAPPED
□For water meters larger than 2”, 5x and 3x Dia. of pipe must be maintained before and after the Meter respectively.
□Calculate time for full device failure to submersion of device discharge port (detailed), it must exceed 8Hrs. Otherwise device must be installed above grade
□All service lines (existing or new) of the same facility (s) in the same lot must be protected and listed on one application
□Backflow Prevention must be NYS-DOH approved, adequately supported, have shutoff valves on both ends (as one assembly) and indicated on the drawings
□Other _____________________________________________________
FLOOR PLAN
□Show the 30” Min. clearance space from front side of device to the farthest
wall or any obstruction
□Show the 8” Min. clearance space from back side of device to the closest wall or any obstruction
□Show the state (existing or new), size &S.# of the meter(s) & all sub meters if any
□Bypass on “DCDA” & “RPDA” devices must be shown to specify clearances
□Bypass around the “BFP” is not acceptable, unless similar BFP is provided
□Show every BFP in conjunction with the Water Meter, Meter Inlet Control Valve (MICV), Meter Test Tee, and Meter Outlet Control Valve (MOCV)
□Drainage details for RPZ & DCV must be shown. How will water be disposed of?
□Other _______________________________________________
_______________________________________________
Elevation Plan
□Provide the 30” Min. Clearance space from centerline of device to floor
□Provide the 60” Max. Clearance space from centerline of device to floor
□Air gap between the RPZ’s relief port and the drain must be Minimum of:
2” – for device size of 0.75” to 1” 3” – for device size of 1.25” to 1.50” 4” – for device size of 2” or larger
□Have clearance >12” from highest point of device to the ceiling or obstruction
□Show the Grade Level and how far from the Floor of device
□Sump pump is not acceptable for “RPZ” installations except if Emergency Power Supply is provided
□If there is no gravity drainage, “RPZ” device must be installed above grade
NOTES
□Print the drainage area in sq. ft. if “RPZ” is installed below Grade Level
□If the BFP is installed more than 60” from centerline (or highest point of Device if vertical), to above finished floor, an OSHA approved platform, and scaffold or ladder must be provided for maintenance and testing.
Height above finished floor for platform should be between 24”-66” to handle
□Between point of entry & BFP, the pipes must be stenciled “FEED TO BFP, DO NOT TAP OR CONNECT TO THIS LINE” at 5’ intervals, at all wall & floor penetrations
□Fire Service(s) must be protected with “BFP” Device
□Fire service(s) must be protected with “RPDA” if there are provisions for chemicals (antifreeze, rust-inhibitors) to be used
□For multi stores/addresses Bldg., all facilities (exist. or new) must be specified and addressed, showing all water meters and sub-meters (if any) to each of the occupancies (tenants)
PLOT PLAN
□Show / verify North arrow on the Plot Plan
□Show / verify the size of water service(s)
□Site plan for the entire facility (lot) showing the closed property line & labeling all water service lines (exist. & new), mains, streets, and location of BFP
□Other__ ___________________________________________________
GEN236 (Application Form)
□Need to fill all the blanks from items 0 to 13
□Need the property owner’s name and signature (original) on item # 7only
□Lack original ink signatures and stamps on both copies
□Have missing / incorrect entries for certain fields
□Valid reason must be given in box 13 Gen 236 form when facility is rated as aesthetically objectionable, and “DCV” is proposed for installation:
1.No defined risk present/anticipated
2.Non Hazardous- Complex Plumbing Fixtures
_____________________________________________________
THESE ARE MINIMUM REQUIREMENTS. PLANS WILL BE REJECTED IF INFORMATION AND MATERIAL ARE NOT GIVEN. PLEASE RESUBMIT 2 SETS OFORIGINAL PLANS WITHIN 30 DAYS OF THE BELOW DATE.
Reviewer:_____________________________ (Tel/ 718 – 595 –5463 • Fax/ 718 – 595 –5252 Date:_________________
Rev 6/10
Page 7
Definitions for Commonly Used Cross-Connection Terms
AFF – Above finished floor.
Airgap – means the unobstructed vertical distance through the free atmosphere between the lowest opening from a pipe, RPZ discharge port, drain line or faucet supplying water to a tank, plumbing fixture floor drain, or any other device. This approved airgap shall be at least double the diameter of the supply pipe, measured vertically, above the overflow of the vessel; and in no case less than one inch. For RPZ’s, an airgap may be based on twice the effective diameter of the relief port.
Airgap Fitting – is a manufactured device which fits on the RPZ’s discharge port and is designed to serve as an airgap. When a manufacturer’s airgap fitting is used and a drain pipe carries the relief port discharge to a drain or sewer, an additional free atmosphere airgap is needed between the end of the relief port discharge pipe and the drain or sewer opening.
Acceptable Backflow Prevention Device – is an acceptable airgap, approved reduced pressure zone device (RPZ), or approved double check valve (DCV, DCVA). Approved devices are those that are listed by The New York State Department of Health.
Aesthetically Objectionable – refers to substances (e.g. stagnant water, hot water) which if introduced into the water supply system, could be a nuisance to other water customers but would not adversely affect human health.
Approved Device – RPZ or DCV, which has been listed by The New York State Department of Health as an acceptable backflow prevention device. Others are not acceptable.
Backflow – The reversal of the normal flow of water caused by either backpressure or backsiphonage.
Containment – the means which isolate customers’ entire facility from the public water system so as to provide the protection necessary to prevent contamination of the public water supply in the event of contamination within the customers’ facilities.
DCV – double check valve, device with two single, independently acting check valves, including tightly closing shutoff valves located at each end of the assembly and suitable connections for testing the watertightness of each check valve, and listed by the New York State Department of Health.
Hazardous Facility – is one in which substances may be present which if introduced into the public water system would or may endanger or have an adverse effect on the health of other water customers.
Horizontal Alignment - the distance from the middle of the device to the nearest front or back wall, and the distance to the nearest side wall. (In some cases, reference can be made to a column, curb, or some fixed conspicuous object.
MOCV – Meter Outlet Control Valve, the line valve that is used in conjunction with the test tee to test the meter. This valve shall be located on the house side of the test tee in order to prevent water flow to and from the facility during meter testing.
RPZ – Reduced Pressure Zone Backflow Prevention Device. A device containing two independently acting check valves on both sides of an automatically operated pressure differential relief valve, all located between two resilient seated shutoff valves. Acceptable devices must be listed by the New York State Department of Health.
Side Clearance – is the clear horizontal distance between the side of the device to the nearest side wall (i.e. wall parallel to the water flow).
Test Tee – a tee used for testing the meter.
Vertical Position – distance above the finished floor AND
the
Page 8
New York City Department of Environmental Protection Form for Report on Test and Maintenance
Bureau of Water and Sewer Operations
of Backflow Prevention Device
Please use a separate form for each device
Initial Test
Complete entire form
Part A- TO BE COMPLETED IN ALL CASES
Annual Test – For the Year ____.
Complete Part A & B Only
Public Water Supply:
County:
Block:
Lot:
Department Use Only
Name & Address of Facility:
Manufacturer & Model of Device:
__________________________________________________
Size & Serial # of Device.
Location of Device:
Part B- TO BE COMPLETED BY CERTIFIED BACKFLOW PREVENTION DEVICE TESTER
Check Valve No. 1
Check Valve No. 2
Differential Pressure
Line Pressure ____ psi
Relief Valve (RPZ only)
Pressure drop across first
Test Before Repair
check valve, psi ____
Leak
(
)
Opened at ____ psi
Date: ____/____/____
Closed tight
Name of Repairer:
Describe repairs,
parts and materials
Name, Lic. # & Seal of Master Plumber.
used.
Date of Repair: ____/____/____
Final test
Water Meter Number:
Meter Reading:
Completion Time of
Type of Service (Please Circle One):
Test (e.g. 3:15 pm):
Domestic
Fire
Combined
Question 1: Are there any connections between the point of entry and the backflow prevention device, or other deficiencies?
CERTIFICATION: This device meets the requirements of an
CERTIFICATION: This device does NOT meet the requirements.
acceptable containment device at the time of testing. I
hereby certify the foregoing data to be correct.
___________________________________
____/____/____
Signature
Date
_________________________________
(____)______-_________
______________________________
PRINT NAME
Telephone No.
Certified Tester No.
Expiration Date
Part C- TO BE COMPLETED BY PROFESSIONAL OR REG. ARCHITECT
Professional Engineer’s or Registered Architect’s Certification:
I have personally checked this installation and I certify that it is in accordance with the approved plans.
Water Supplier Approval #:
[ ] I am the Designer of Record. [ ] I am NOT the Designer of Record.
PE/RA Printed Name:
Company:
Address:
Signature, Seal & Date:
Minor Installation Changes (describe):
Attach additional sheets if required.
Part D – TO BE COMPLETED BY MASTER PLUMBER
Master Plumber’s Certification: [ ] I am [ ] I am NOT the Licensed Master Plumber of Record. I have personally checked this installation and I certify that it is in accordance with the Building Department’s Requirements.
Building
Department
Number: (Use Sticker)
Plumber’s Printed Name:
_______________________________________
Plumber’s License #:
Signature, Seal and Date:
NOTE: Send one completed form with original ink signatures and original ink or impressed seals to NYC Department of Environmental Protection, Division of Permitting & Inspections, Cross Connection Control Unit, 59-17 Junction Boulevard, 3rd Fl. Low-Rise, Flushing, NY 11373 within 30 days of installation and initial testing.
Page 9
Before you dive into filling out the NYC Department of Environmental Protection (DEP) Backflow Prevention Device Installation form, it's key to understand the importance of this process. This initiative is crucial for safeguarding New York City's water supply from potential contaminants. Whether you're a property owner required to comply due to the nature of your facilities or seeking to understand your obligations, following the correct steps ensures the safety and compliance of your property's water systems.
Here are the essential steps to prepare and submit your Backflow Prevention Device Installation plans to the NYC DEP:
For those who believe their premises might not require a Backflow Prevention Device, a Professional Engineer, Registered Architect, or Licensed Master Plumber can submit a request for exemption to the DEP for consideration. If approved, an exemption letter will be issued. Ensuring you follow these steps carefully not only complies with city regulations but also plays a critical part in protecting the public and the environment.
What is the purpose of the DEP Backflow Prevention Program?
The DEP Backflow Prevention Program aims to protect New York City's water supply from contamination. Property owners may pose a risk to the water supply are required to install a backflow prevention device. This device ensures that water does not flow back into the city's drinking water system.
Who needs to comply with these requirements?
Owners of properties with facilities that could contaminate the water supply must comply. This includes, but is not limited to, bakeries, auto body shops, car washes, chemical processing plants, commercial kitchens, dental offices, and more.
What are the steps for compliance?
What is required in the plan submission?
Plan submissions must include two sets of plans and two application originals (Form GEN-236), bearing the original signature and seal of the Professional Engineer or Registered Architect. These plans must detail the installation and comply with DEP guidelines.
What happens if the device installation does not follow the approved plans?
If the installation does not conform to the approved plans, the DEP will notify the owner and the Professional Engineer or Registered Architect. The issues must be corrected and re-certified until they are acceptable to DEP standards.
How often must the backflow prevention device be tested?
The device must be tested at least once a year by a state-certified tester. The results of this test must be reported to the DEP using Form GEN 215B.
What if a property owner believes their premises does not require a Backflow Prevention Device?
Owners who believe their property does not require a device may submit a request for exemption. This request must be sent to the DEPI Cross Connection Control Unit and, if approved, an exemption letter will be issued.
What are some design considerations mentioned for backflow prevention devices?
The guidelines specify design requirements like clearance from walls, installation between the meter and meter test tee, drainage details for Reduced Pressure Zone (RPZ) devices, and elevation plans for installation. Additionally, if installed in a basement or cellar, flood level considerations must be taken into account.
Can any plumber install and test the backflow prevention device?
No, the installation must be done by a New York City Licensed Master Plumber, and the testing must be carried out by a State Certified Backflow Prevention Device Tester who is either a licensed plumber or employed by one.
What should owners do if they need help with their backflow prevention device plans or installation?
Owners lacking experience in planning and designing backflow prevention device installations are advised to consult with professionals. This ensures that plans meet DEP standards and avoid delays and additional expenses.
Filling out the New York City Department of Environmental Protection (NYC DEP) Backflow Prevention Device form can be a complex process. There are common mistakes that people make when completing this form, which can lead to delays in approval or even the need for re-submission. By being aware of these pitfalls, property owners and filing applicants can streamline the process, ensuring their properties are protected and compliant with city regulations.
One major area where mistakes occur is in the preparation and submission of documents. Applicants often:
Additionally, the correct selection and installation of the Backflow Prevention (BFP) devices themselves are critical. Common mistakes include:
In addition to the above points, it's crucial to ensure that all installations comply with specific measurements and settings, such as air gap requirements and clearance space from the device to the ceiling, floor, and walls. Furthermore, the administrative aspect such as having the device tested by a state-certified tester and submitting the "Report on Test and Maintenance of Backflow Prevention Device" within the stipulated timeframe is equally important. Failing to adhere to these guidelines not only leads to non-compliance but can also pose a significant risk to the city's water supply.
Ultimately, the process of filing and installing backflow prevention devices requires careful attention to detail and adherence to the NYC DEP's guidelines. By avoiding these common mistakes, applicants can ensure a smoother approval process and contribute to the safeguarding of New York City’s water supply system.
When it comes to safeguarding New York City's water supply, the NYC DEP Backflow Prevention Program plays a pivotal role. Yet, understanding the landscape of legal and regulatory requirements can be daunting. The key to compliance lies not only in submitting the NYC DEP Backflow form but also in navigating the ancillary documents and submissions essential for a frictionless approval process. Below are nine crucial documents often associated with the Backflow Prevention form, which serve to streamline, complement, or enhance the process of ensuring water safety and compliance.
Navigating the regulatory waters of New York City’s DEP Backflow Prevention Program requires more than just submitting the right form. Understanding and utilizing the full gamut of required and supportive documentation ensures not only compliance but also the protection of our precious water resources. Approach these steps with care and thoroughness to contribute to a safer, healthier public water system for all.
The NYC Department of Buildings (DOB) Permit Application is closely related to the NYC DEP Backflow Form due to its requirement for pre-approved plans before installation or construction. Both documents ask property owners to submit detailed plans for review, emphasizing the need for compliance with city standards to ensure public safety and adherence to regulations. The DOB Permit Application process also involves several steps for approval, similar to the backflow form’s procedure for plan approval, installation, testing, and reporting.
Another comparable document is the Environmental Control Board (ECB) Violation form. This violation form is issued when property owners do not comply with regulations, similar to how DEP would issue notices for non-compliance with backflow prevention device regulations. Both forms require action to resolve potential hazards or legal issues, emphasizing maintaining public health and safety standards.
The Annual Water Quality Report, distributed by local water authorities, shares similarities with the NYC DEP Backflow Form in its aim to protect public health. While the water quality report informs the public about the water supply's status, the backflow form is a proactive measure ensuring contaminated water does not enter the public water system. Both documents are instrumental in maintaining the safety and integrity of the city’s water supply.
The Hazardous Materials Management Plan parallels the backflow prevention plan in its purpose to mitigate risks associated with dangerous substances. Where the backflow form focuses on preventing water supply contamination, the hazardous materials plan outlines strategies to manage and contain chemicals and other harmful materials. Both documents require detailed planning and regular inspections to ensure public safety.
The Construction Site Safety Plan is akin to the NYC DEP Backflow Form, as it emphasizes the protection of the community and workers from potential hazards. Just as the safety plan outlines measures to mitigate risks during construction, the backflow form specifies installation and testing protocols for devices that prevent water contamination. Both processes involve stringent oversight to prevent accidents and ensure a safe environment.
Fire Safety Plans are also related to the DEP Backflow Form since they are precautionary measures designed to protect buildings’ occupants. While fire safety plans include evacuation procedures and equipment checks, the backflow form ensures water used for firefighting or other purposes does not become a source of contamination. Both require regular updates and compliance checks to remain effective.
The Certificate of Occupancy application process is similar to the backflow prevention device installation and approval process. Both require property owners to demonstrate compliance with specific standards before they can be legally occupied or utilized. The Certificate of Occupancy certifies that a building is suitable for habitation, while the backflow form affirms the property's water safety measures are in place.
Lastly, the Lead Paint Compliance Form, required for certain types of construction and renovation, shares objectives with the backflow prevention form. Both documents are concerned with public health, requiring property owners to take specific actions to prevent lead exposure or water contamination. Compliance ensures that buildings are safe for occupants, emphasizing preventative measures for public safety.
When filling out the NYC DEP Backflow Prevention Device Installation form, it's important to follow specific guidelines to ensure compliance and avoid common mistakes. Here are some dos and don'ts to keep in mind:
Compliance with the guidelines provided by the DEP ensures that the installation of backflow prevention devices contributes effectively to the safeguarding of New York City's water supply system from contamination risks. Adhering to these dos and don'ts supports a smooth approval and installation process, helping to protect public health and the integrity of the water system.
When engaging with the New York City Department of Environmental Protection (NYC DEP) Backflow Prevention Program and the associated forms, several misconceptions often arise. Understanding the correct information can help streamline the process for property owners and professionals alike.
Misconception 1: The DEP Backflow form is optional for some properties. Every owner of a property that poses an actual or potential risk of contamination to New York City's water supply, regardless of the property's use or size, is required to comply with the regulations. This includes a wide range of facilities from bakeries to veterinary offices.
Misconception 2: Any plumber can install the backflow prevention device once the plan is approved. Only a New York City Licensed Master Plumber is authorized to perform the installation in accordance with the approved plans. This ensures the work meets both the DEP and the Building Department’s requirements.
Misconception 3: Once installed, backflow prevention devices do not require further testing or inspection. After installation, the device must be tested by a state-certified backflow-prevention device tester at least once a year. It is crucial for maintaining the safety and integrity of the city’s water supply.
Misconception 4: The approval process is a one-time submission. Plans and applications must be corrected and resubmitted as necessary until they are acceptable. This iterative process ensures that all potential risks are adequately addressed before approval is granted.
Misconception 5: Architectural considerations can provide a basis for exemption. For new facilities, granting exemptions based solely on aesthetic considerations and architectural design is unacceptable. The architecture must accommodate the containment devices to protect the public water system.
Misconception 6: Any backflow prevention device is acceptable as long as it's installed. The device installed must be approved by the New York State Department of Health (NYS DOH). Using an unapproved device can lead to non-compliance and potential risks to public health.
By clarifying these misconceptions, property owners and professionals can better navigate the requirements of the NYC DEP Backflow Prevention Program, ensuring the safety of the city's drinking water supply through compliance and proper backflow prevention measures.
Filling out and using the NYC DEP Backflow Prevention Form is essential for property owners in New York City to ensure the protection of the city's water supply from contamination. Here are seven key takeaways from the process:
Understanding and following the guidelines for backflow prevention is vital for protecting public health and complying with local laws. Ensuring that the necessary steps are taken for the preparation, submission, and approval of plans for the installation and maintenance of backflow prevention devices is essential for all affected property owners.
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