CCC Program Responsibilities include enforcement action-related procedures or circumstances. Do not CCC Program Activity Responsible Party (Check one per row) Customer Purveyor Hazard Evaluation by DOH-certified CCS Backflow preventer (BP) ownership BP installation BP inspection (for proper installation all BPs) initial – BP test (for testable assemblies) initial BP inspection (Air Gaps and AVBs) annual BP test (for testable assemblies) annual BP maintenance and repair Backflow Protection for Fire Protection Systems Please remember to enter number of days allowed if you require retrofitting. PWS coordinates with on CCC issues for fire protection systems (FPS). Y N N/A AHJ PWS coordinates with on CCC issues for FPS. Y N N/A local Fire Marshal PWS ensures backflow prevention is installed before serving connections with FPS. Y N new PWS requires retrofits to FPS. Y (No. of days allowed: _____) N N/A high-hazard _____) PWS requires retrofits to FPS. Y (No. of days allowed: N N/A low-hazard Backflow Protection for Irrigation Systems level of backflow prevention required on irrigation Not Addressed AVB Minimum systems chemical addition. PV/SVBA DCVA RPBA without PWS currently inspects AVBs upon installation. Y N N/A initial PWS currently inspects AVBs upon repair, reinstallation, or relocation. Y N N/A Used Water PWS prohibits, by ordinance, rule, policy, or agreement, the intentional return of used Y N water (e.g., for heating or cooling) into the distribution system. If not prohibited at present, date plan to prohibit. Date (mm/dd/yyyy): N/A Current number of service connections returning used water to distribution system. Backflow Protection for Unapproved Auxiliary Water Supplies1 NOT Interconnected with PWS Show the minimum backflow preventer and type of protection required for service connections with unapproved auxiliary water supplies Check only one box per row. NOT interconnected with the PWS. service connections. None DCVA RPBA AG Existing Type of protection required. None In-premises protection Premises isolation service connections. None DCVA RPBA AG New Type of protection required. None In-premises protection Premises isolation
CCC Program Responsibilities Do not include enforcement action-related procedures or circumstances. CCC Program Activity Responsible Party (Check one per row) Customer Purveyor Hazard Evaluation by DOH-certified CCS Backflow preventer (BP) ownership BP installation BP initial inspection (for proper installation – all BPs) BP initial test (for testable assemblies) BP annual inspection (Air Gaps and AVBs) BP annual test (for testable assemblies) BP maintenance and repair Backflow Protection for Fire Protection Systems Please remember to enter number of days allowed if you require retrofitting. PWS coordinates with AHJ on CCC issues for fire protection systems (FPS). Y N N/A PWS coordinates with local Fire Marshal on CCC issues for FPS. Y N N/A PWS ensures backflow prevention is installed before serving new connections with FPS. Y N PWS requires retrofits to high-hazard FPS. Y (No. of days allowed: _____) N N/A PWS requires retrofits to low-hazard FPS. Y (No. of days allowed: _____) N N/A Backflow Protection for Irrigation Systems Minimum level of backflow prevention required on irrigation systems without chemical addition. Not Addressed AVB PV/SVBA DCVA RPBA PWS currently inspects AVBs upon initial installation. Y N N/A PWS currently inspects AVBs upon repair, reinstallation, or relocation. Y N N/A Used Water PWS prohibits, by ordinance, rule, policy, or agreement, the intentional return of used water (e.g., for heating or cooling) into the distribution system. Y N If not prohibited at present, date plan to prohibit. Date (mm/dd/yyyy): N/A Current number of service connections returning used water to distribution system. Backflow Protection for Unapproved Auxiliary Water Supplies1 NOT Interconnected with PWS Show the minimum backflow preventer and type of protection required for service connections with unapproved auxiliary water supplies NOT interconnected with the PWS. Check only one box per row. Existing service connections. None DCVA RPBA AG Type of protection required. None In-premises protection Premises isolation New service connections. None DCVA RPBA AG Type of protection required. None In-premises protection Premises isolation
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