NYC-DEP Backflow Prevention Assembly Report
This document is used for the test and maintenance of containment backflow prevention assemblies. It provides instructions for certified testers to report results and ensure compliance with NYC regulations. Essential for facility managers and plumbing professionals involved in backflow prevention.
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How do I fill this out?
Filling out the Backflow Prevention Assembly Report requires careful attention to detail. Begin by selecting either the Initial Test or Annual Test to determine which parts to complete. Follow the instructions in each section to ensure accurate reporting.
How to fill out the NYC-DEP Backflow Prevention Assembly Report?
1
Select Initial Test or Annual Test.
2
Fill out all applicable parts according to instructions.
3
Enter accurate details about the assembly and its location.
4
Complete the report with the certified tester's information.
5
Review and ensure all information is correct before submission.
Who needs the NYC-DEP Backflow Prevention Assembly Report?
1
Plumbing professionals who install backflow prevention assemblies.
2
Facility managers responsible for compliance with NYC water regulations.
3
NYS certified backflow testers conducting inspections and tests.
4
Registered architects involved in building projects with assemblies.
5
Licensed master plumbers overseeing installation or repair work.
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What are the instructions for submitting this form?
Completed forms should be sent to NYC-DEP-BWSO, Cross-Connection Control Unit, 59-17 Junction Blvd., 3rd Fl. Low-Rise, Flushing, NY 11373. Ensure that all forms are signed with original ink signatures and include any necessary seals. It is advised to keep a copy of the submitted form for your records.
What are the important dates for this form in 2024 and 2025?
Important submission dates for the completed form are 30 days after initial testing or installation. Ensure timely submission to avoid penalties. Keep track of important dates to maintain compliance in the upcoming years.
What is the purpose of this form?
The purpose of this form is to ensure the safe operation of backflow prevention assemblies within public water systems. By documenting the test results, facilities can demonstrate compliance with relevant regulations. This form plays a vital role in preventing contamination of water supplies.
Tell me about this form and its components and fields line-by-line.
- 1. Initial Test: Indicates whether this is the initial testing of the assembly.
- 2. Annual Test: Indicates if this is an annual recertification test.
- 3. Facility Information: Includes name, address, and location details of the facility.
- 4. Tester Information: Details about the certified tester responsible for completion.
- 5. Test Results: Actual readings and observations from the test conducted.
- 6. Certifications: Signatures and certification of compliance from relevant professionals.
What happens if I fail to submit this form?
Failure to submit this form may lead to compliance issues with local regulations.
- Legal Penalties: There may be fines or legal actions for non-compliance.
- Water Supply Risks: Unaddressed backflow issues may compromise water supply safety.
- Increased Inspection Frequency: Failure to report may result in more frequent inspections by authorities.
How do I know when to use this form?
- 1. Initial Installation: To certify the initial testing of a newly installed assembly.
- 2. Annual Maintenance: To report annual tests required for compliance.
- 3. Repairs and Modifications: For documenting repairs made to existing assemblies.
- 4. Change of Ownership: Required during a change in facility ownership.
- 5. Regulatory Compliance: To ensure all local regulatory requirements are met.
Frequently Asked Questions
What is the purpose of this PDF?
This PDF is used for documenting the test and maintenance of backflow prevention assemblies.
Who should fill out this form?
Certified backflow assembly testers and licensed master plumbers should fill this form.
Can I edit this PDF online?
Yes, you can easily edit the PDF using our online tools.
How do I share the edited PDF?
You can share the edited PDF via email or create a shareable link.
What information do I need to complete the form?
You will need details about the assembly, test results, and tester credentials.
Is a signature required?
Yes, a signed certification is required from the tester and plumber.
What if I make a mistake on the form?
You can edit the PDF to correct any mistakes before final submission.
How do I submit the form?
Completed forms should be mailed to the NYC-DEP Cross-Connection Control Unit.
Are there deadlines for submission?
Yes, completed forms must be submitted within 30 days of installation.
Can I print this PDF after editing?
Absolutely, you can download and print the edited PDF anytime.
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