Do I need a notary for the Backflow Prevention Device Approval Application?

No. This form is signed and dated without a notary, but the design professional’s original-ink signature and seal are required on all copies.

What documents must accompany the application?

The application must be accompanied by plans, specifications, and an engineer’s report describing the project in detail. The form also says to provide four copies of those materials.

What information does the application request?

It requests facility, owner, device, service, and design professional information, along with water pressure, estimated installation and design costs, and the degree of hazard.

Goshen, NY · Orange County

No notary required

Application for Approval of Backflow Prevention Devices

This application requests approval of backflow prevention devices and is completed by the facility owner and design professional.

What this form is

Use this application to request approval for backflow prevention devices at a facility, including an initial installation or replacement and work involving a new service, new building, or major renovations. It asks for facility and owner details, device and service information, design professional credentials, water pressure, estimated costs, and the degree of hazard. Applicants must include plans, specifications, and an engineer’s report describing the project.

Who needs it

Facility owners seeking approval for backflow prevention devices must complete the application with information from the design engineer or architect.

How to submit it

Submit the project first to the water supplier, which will forward it to the local public health engineer. Prepare the form in quadruplicate with four copies of all plans, specifications, and descriptive literature.

About notarization

This form is signed and dated without a notary; the design professional’s original-ink signature and seal are required on all copies.

How to submit this form

1
Download The Application
Download the Backflow Prevention Device Approval Application.
2
Complete The Form
Print or type entries except signatures, and complete the requested facility, owner, device, service, and project information.
3
Gather Project Documents
Include plans, specifications, and an engineer’s report describing the project; prepare four copies of each.
4
Submit To The Water Supplier
Prepare the form in quadruplicate and submit the project first to the water supplier for forwarding to the local public health engineer.

Frequently asked questions

Do I need a notary for the Backflow Prevention Device Approval Application?: No. This form is signed and dated without a notary, but the design professional’s original-ink signature and seal are required on all copies.
How do I submit the application?: Submit the project first to the water supplier, which will forward it to the local public health engineer. Prepare the form in quadruplicate and include four copies of all plans, specifications, and descriptive literature.
What documents must accompany the application?: The application must be accompanied by plans, specifications, and an engineer’s report describing the project in detail. The form also says to provide four copies of those materials.
What information does the application request?: It requests facility, owner, device, service, and design professional information, along with water pressure, estimated installation and design costs, and the degree of hazard.

Need something notarized?

This Application for Approval of Backflow Prevention Devices doesn’t need a notary — but if you have another Goshen form that does, a commissioned online notary can help.