HomeMy WebLinkAbout2021-04-26 DOH Approval of Backflow Prevention DevicePh: (607) 274-6688 Fx: (607) 274-6695
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https://tompkinscounty-my.sharepoint.com/personal/sfreyburger_tompkins-co_org/Documents/Approval of Plans.docx
Created 2/8/19
ENVIRONMENTAL HEALTH DIVISION www.tompkinscountyny.gov/health/eh
Approval of Plans Public Water Supply – Backflow Prevention Device(s)
Tompkins County Environmental Health Record #: EH-PR-20-006
These plans are APPROVED in accordance with the New York State Sanitary Code 5-1 and consists of 18 sheets:
Design Professional: Daniel D. Turner, P.E.
Project/Job #: 001.16.01.02 Lakeview Health Services West end Heights
Plan Design Date: 11.30.2020 Plan Revision Date: NA
Project Location: 701 West Court Street
Municipality: City of Ithaca
Tax Parcel Id: 500700-59.-2-10
Project Description: 4" Domestic and 6" Fire Protection Backflow Prevention
This approval of plans is issued subject to the following conditions:
1)THAT this approval is valid until 4/26/2023 and new plans must be submitted for approval if the
project is not completed by then.
2)THAT within 45 days of installation, the attached certification will be completed and returned to
the water supplier, City of Ithaca and the Tompkins County Health Department.
3)THAT a certified backflow prevention device tester checks the above backflow prevention
device(s) at least yearly and reports the results to the water supplier indicated above.
4)THAT any connection made prior to the backflow prevention device(s) shall render this approval
void.
The approved plans and Report of Test & Maintenance of Backflow Prevention Device Form DOH-1013 is attached. Form DOH-1013 is used as a Request for Completed Works, which consists of two parts:
1)The initial test of the device(s) by a certified backflow prevention device tester.
2)A Certification that installation is in accordance with approved plans by the design
professional or the water supplier.
, P.E. Approval Date Scott Freyburger, Public Health Engineer
ec: Design Professional, Owner, CEO, PWS Contact, TCHD: Elizabeth Cameron, Program Staff
scan: Signed copy to Accela and F:Drive
4/26/2021