Onondaga County, NY · Onondaga County
Engineer's Report Form for Approval of a Backflow Prevention Device
This engineer's report form provides project and device details for engineers seeking approval of backflow prevention devices for a facility.
At a glance
- Issued by
- City of Onondaga County · Onondaga County, Onondaga County, New York
- Notarization
- Not required: file this form without a notary.
- Official source
- onondaga.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
Engineers use this report to provide information about a facility or project and its proposed backflow prevention devices for approval. It asks for owner and project details, device specifications, water use, facility classification, potential hazards, and site conditions. The form directs the engineer to return it to the public water supplier and requests the engineer's stamp and signature.
Who needs it
An engineer completing a report for approval of proposed backflow prevention devices for a facility or project needs this form.
How to submit it
Return the completed report to the Public Water Supplier, as directed on the form; it does not list an address or other submission method.
About notarization
The engineer signs and stamps this report without a notary; any attached device details and current annual test reports are not described as requiring notarization.
How to submit this form
- 1
Download the Form
Download the fillable Engineer's Report Form for Approval of a Backflow Prevention Device.
- 2
Complete the Report
Enter the facility, owner, engineer, proposed device, water-use, and project details requested on the form.
- 3
Gather Device Records
If existing backflow prevention devices are present, attach a sheet with their make, model, size, and serial number, plus current annual test reports.
- 4
Sign and Stamp
Use the designated box for the engineer's stamp and signature, and enter the report completion date.
- 5
Return the Report
Return the completed report to the Public Water Supplier.
Frequently asked questions
- What is the Engineer's Report Form for Approval of a Backflow Prevention Device?
- It collects facility, project, water-use, hazard, and proposed device information for an engineer's backflow prevention device approval report.
- Who completes this backflow prevention report?
- The form requests facility and owner details, proposed device specifications, site and water-system information, and the engineer's stamp and signature.
- Do I need a notary for the backflow prevention report?
- No. The engineer signs and stamps the report without a notary; the form does not say that attached device details or annual test reports must be notarized.
- How do I submit the backflow prevention report?
- Return the completed report to the Public Water Supplier, as stated on the form. It does not provide an address or another submission method.