Nyc Dep Backflow Form – Fill Out and Use This PDF

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.

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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.

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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.

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Guidelines for Filling out Proposal of Backflow Prevention Device(s) Installation

General:

ƒProvide two sets of plans and two GEN 236 application forms bearing the original signature and seal of the applicant.

ƒAll services of the same facility shall be protected and listed on the application.

ƒBackflow Prevention (BFP) Device(s) shall be NYS – DOH approved.

ƒNo 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.

ƒNo take offs are allowed on the street side of the device except approved combined services.

ƒPiping to be unbranched and unrestricted from main to device except for meter.

ƒThe device shall be installed between the meter and the meter test tee.

ƒMeter test tee shall be capped or plugged.

ƒFor 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.

ƒNeed to provide Elevation Plan, Floor Plan, Plot Plan, Engineering Report and notes.

Floor Plan

ƒShow a minimum of 30 in. clearance from the side of the device to the farthest wall or obstruction.

ƒShow a minimum of 8 in. clearance from the side of the device to the closest wall or obstruction.

ƒShow size of the meter.

ƒPlan view showing every BFP in conjunction with the water meter, test tee, meter inlet control valve (MICV) and meter outlet control valve (MOCV).

ƒDrainage details for RPZ’s must be shown.

Elevation Plan:

ƒProvide a minimum of 30 in. clearance space from the centerline of device to floor.

ƒProvide a maximum of 60 in. clearance space from the centerline of device to floor.

ƒProvide a minimum clearance of 12 in. from the device to the ceiling.

ƒAir 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

ƒIf there is no gravity drainage, device shall be installed above grade. Sump Pump is not acceptable for gravity drainage.

Plot Plan:

ƒShow north arrow

ƒShow the size of water service

ƒSite plan for the entire facility must show the closed property line and labeling or all water service lines, mains, streets, location of BFP.

Notes:

ƒPrint the drainage area in sq. ft. if you are installing in the basement or the cellar.

ƒIf 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

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