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Backflow-Prevention-Install-Inspect-Form
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This form has been modified since it was saved. Please review all fields before submitting.
Your form submission will be reviewed within 24 hours by CFPUA's Community Compliance Section. You will be contacted if any further info is needed. After the 24-hour review period, please contact Customer Service at 910-332-6550 or use the Customer Service link at right, select the “Backflow/Meter Set Process” and complete that form to initiate the process to have the meter set.
Customer Service
Project Address
*
GENERAL OR UTILITY CONTRACTOR NAME
*
Foreman:
*
Address
*
Phone Number
*
Email
*
PLUMBER OR FIRE SPRINKLER CONTRACTOR NAME
*
License
*
Address
*
Phone Number
*
Email
*
Backflow Prevention Assembly Information:
Replace the existing backflow?
*
Yes
No
Serial Number being replaced
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Manufacturer
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Model
*
Size
*
Serial Number
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Location Onsite
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Installation Type
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Temporary
Permanent
Inspection
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Ready for Inspection
Will call for Inspection
Type
*
Reduced Pressure (RP)
Double Check (DC)
Reduced Pressure Detector (RPDA)
Double Check Detector (DCDA)
Type of commercial hazard or water use
*
Automotive
Car Wash
Commercial
Construction
5 (or more) story building
Fire Service
Food Service
Industrial
Irrigation Meter
Irrigation Subtraction Meter
Laundry
Medical/Institutional
Mortuary
Mutli-Family
Pesticide
Pool
Waterfront
Wastewater Treatment
Other use
Backflow Prevention Assembly Installation Guide
• The backflow prevention assembly should be as close to the water meter or service connection as possible. In all cases it shall be before the first branch in the water service. Call for more information about isolation backflow assemblies.
• The double check valve and reduced pressure assemblies shall be installed at least 12 inches above the finished grade, flood level, or floor.
• The maximum installation height of a backflow prevention assembly is sixty inches. • An enclosure shall be provided that protects the assembly from theft, vandalism, tampering, weather, and freezing.
• In the floor, underground, and vault installations are prohibited.
• There shall be 12 inches clearance on all sides of the assembly.
• Electrical equipment, outlets and breaker boxes shall not be located beneath the assembly. • Only in-line testable assemblies appro
• The type of assembly shall be appropriate for the hazard as identified by the Community Compliance Office
• Prior to installing assemblies it is recommended that the Community Compliance Office be contacted to verify that the type of assembly being used is appropriate for thehazards.
• Installation, relocation, replacement, and removal of backflow prevention assemblies require a CFPUA permit and inspection and a separate New Hanover County plumbing permit and inspection. Water meters will not be set until the CFPUA has inspected and approved the backflow prevention assembly and its installation.
• It is the responsibility of the installer to ensure that backflow prevention assemblies function properly and are tested by a certified tester within 15 days of the installation.
• G.S. 143-155: Local government water systems and large community water systemsshall require separate meters for new in-ground irrigation systems on lots platted and recorded in the office of the register of deeds in the county or counties in which the real property is located after July 1, 2009, that are connected to their systems. A backflow prevention assembly is required on irrigation services and shall be permitted separately from the construction water BFP.
Signature of Plumber/Contractor
*
By typing your name here you affirm you have read and will abide by CFPUA backflow prevention assembly installation guidelines.
Date
Date
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