City of Santa Maria
Cross-Connection
Control Plan
D
eveloped in Compliance with Santa Maria Municipal Code
Chapter 8-10A Cross-Connections
_________________________________________ _____________ D
irector of Utilities Date
Attachment C
Cross-Connection Control Program Introduction
City of Santa Maria Regulatory Review - 12/30/2025
Cross-Connection Control Plan 2
Cross-Connection Control (CCC) Plan
Public Community Water System (PWS) Information
Public Water System Name C ity of Santa Maria
Public Water System Number CA4210011
Water System Ownership Type Public
Number of Single-Family Residential Service
Connections1
1 9207
Number of Multifamily Residential Service
Connections1
8 70
Number of Commercial Connections1 1 858
Number of Industrial Service Connections1 9 5
Number of Agricultural Service Connections1 0
Number of Landscape Irrigation Connections1 6 34
Number of Other Connections 324
Total Number of Service Connections 22988
1 – PWS may also indicate number of Responsible Parties with multiple service c
onnections or served by master meter for clarity.
PWS Background Cross-Connection Control Information
Number of Fire Protection System Service
C
onnections (Residential)
~122
Number of Fire Protection System Service
Connections (Non-Residential)
~700
Number of Air Gaps used for backflow protection
at the service connection
1 Number of Service Connections where internal
protection is used in lieu of premises containment
To be determined during hazard
assessments.
Number of Recycled Water (RW) use sites 0
Number of Swivel-ells used for backflow protection
at the service connection (applies to Recycled
Water use sites)
0 Number of Sites requiring a water user supervisor
(CCCPH Section 3.2.2(f)) – applies to any sites
using recycled water, complex piping systems, or
a user supervisor deemed necessary by the PWS
0 Attachment C
Cross-Connection Control Program Introduction
City of Santa Maria Regulatory Review - 12/30/2025
Cross-Connection Control Plan 3
Table of Contents and Attachments
Cross-Connection Control (CCC) Plan ..................................................................................... 2 Public Community Water System (PWS) Information ............................................................. 2 PWS Background CCC Information ........................................................................................ 2 Table of Contents and Attachments ....................................................................................... 3 Cross-Connection Control Plan Certification Page ............................................................... 5 Definitions ................................................................................................................................ 6 City of Santa Maria Cross-Connection Control Program ...................................................... 8 Program Requirements .......................................................................................................... 8 City of Santa Maria Cross-Connection Control Plan ............................................................... 9 Operating Rules or Ordinances .............................................................................................. 9 City Standards ........................................................................................................................ 9 Cross-Connection Control Program Coordinator .................................................................10 Cross-Connection Hazard Survey Schedule for Initial Hazard Assessments ....................12 Element 1 – Hazard Assessments .........................................................................................13 New Water Connections ........................................................................................................13 Commercial, Industrial, and Landscape Service Connections ...............................................13 Agricultural Service Connections ...........................................................................................13 Single Family and Multi-Family Residential Service Connections ..........................................14 Temporary Service Connections ............................................................................................14 Subsequent Hazard Assessments .........................................................................................14 Element 2 – Prevention of Contamination .............................................................................15 Conditions for Service ...........................................................................................................15 Backflow Prevention Assembly Determination .......................................................................17 Existing Backflow Prevention Assemblies ..........................................................................17 Requirements ....................................................................................................................17 Additional Premises Requiring Premises Containment.......................................................18 Backflow Prevention Assembly Requirements ...................................................................19 Installation Criteria for Backflow Protection ............................................................................19 Installation Requirements ...................................................................................................19 Air Gap Requirements........................................................................................................19 Schedule for Installation of BPAs ...........................................................................................20 Enforcement ..........................................................................................................................20 Element 3 – Certified BPA Testers and Certified CCC Specialists ......................................21 Backflow Incident Reporting Obligations of BPA Testers .......................................................21 Attachment C
Cross-Connection Control Program Introduction
City of Santa Maria Regulatory Review - 12/30/2025
Cross-Connection Control Plan 4
Pre-Approved Lists ................................................................................................................21 Denial, Suspension or Revocation of BPA Tester or CCC Specialist Approval ......................21 Appeals ..............................................................................................................................22 Quality Assurance ..............................................................................................................23 Element 4 – Backflow Prevention Assembly Testing ...........................................................24 Inspection and Testing of Backflow Preventers and Air Gaps ................................................24 BPAs ..................................................................................................................................24 Air Gaps .............................................................................................................................24 Frequency of Inspection and Testing .....................................................................................24 Responsibility for Inspection and Testing ...............................................................................25 Notification of Inspection and/or Testing ................................................................................25 Approved Test Procedures ....................................................................................................25 Repairs ..................................................................................................................................25 Element 5 – Enforcement .......................................................................................................26 Conditions for Disconnection .................................................................................................26 Annual Testing Conditions for Disconnection.........................................................................26 Removal of BPA is Grounds for Disconnection ......................................................................27 Reported Backflow Incident Investigation and Disconnection ................................................27 Appeal of Enforcement Decisions ..........................................................................................27 Element 6 – Backflow Incident Response, Reporting, and Notification ..............................28 Backflow Incident Response Procedure ................................................................................28 Backflow Incident Response Plan ..........................................................................................28 Backflow Incident Notification ................................................................................................28 Element 7 – Recordkeeping ...................................................................................................29 Element 8 – Public Outreach and Education .........................................................................31 Local Entity Coordination .......................................................................................................31
Attachment A – Copy of legal authority (Operating rules, Ordinance, Resolution, By- law, Service Contract) used to implement CCC Program
Attachment B – Backflow Incident Response Plan
Attachment C – Questionnaire
Attachment D – Hazard Assessment
Attachment E – L ist of Air Gaps and Air Gap Inspection Procedure
Attachment C
Attachment C
Cross-Connection Control Program Introduction
City of Santa Maria Regulatory Review - 12/30/2025
Cross-Connection Control Plan 6
Definitions
Unless otherwise defined, all terms used in this Cross-Connection Control Plan pertaining to cross-connection control have the same definitions as those contained in the Cross-Connection Control Policy Handbook (CCCPH).
Other Defined Terms:
Approved: Accepted by the Director of Utilities as meeting an applicable specification stated or cited in the Cross-Connection Control Program, or as suitable for the proposed site.
Approved Backflow Prevention Assembly: Or “BPA” means a mechanical assembly designed and constructed to prevent backflow, such that while in-line it can be maintained and its ability to prevent backflow, as designed, can be field tested, inspected and evaluated.
Backflow: An undesired or unintended reversal of flow of water and/or other liquids, gases, or other substances into a public water system’s distribution system or approved water supply.
Cross-Connection: Any actual, potential, or temporary connection (such as swing connections, removable sections, four-way plug valves, spools, dummy sections of pipe, swivel or change-over devices, sliding multiport tubes, or similar) or structural arrangement between the public potable water distribution system, including a piping system connected to the Distribution System and located on the premises of a water user or available to the water user, and any source or system containing liquid, gas, or other substances that may enter the public potable water system.
Cross-Connection Control Plan (CCC Plan): The City’s guiding document establishing the methods, procedures, and policies the City has in place to comply with the requirements of the Cross-Connection Control Policy Handbook. This document.
Cross-Connection Control Policy Handbook (CCCPH): The State of California cross- connection control program standards as established in the Cross-Connection Control Policy Handbook (CCCPH), which became effective July 1, 2024, and are incorporated into the State of California’s Drinking Water Regulations. The CCCPH and its standards apply to all California public water systems (PWSs), as defined in California’s Health and Safety Code (CHSC, section 116275 (h)). Compliance with this CCCPH is mandatory for all California PWSs. The CCCPH updated and replaced Title 17 of the California Code of Regulations.
Cross-Connection Control Program (CCC Program): The overarching program in place to regulate cross-connection controls in the City and comply with the CCCPH. The CCC Program includes the CCC Plan, enabling rules and ordinances, City standards including building, plumbing, and fire standards, and the personnel to enforce the regulations.
Attachment C
Cross-Connection Control Program Introduction
City of Santa Maria Regulatory Review - 12/30/2025
Cross-Connection Control Plan 7
Director of Utilities: The administrator/manager in charge of all aspects of the Utilities Department.
Distribution System: The network of conduits used for the delivery of potable water from the source to the responsible party's water system.
Potable Water: Water which is satisfactory for drinking, culinary, and domestic purposes and meets the requirements of the United States Environmental Protection Agency (USEPA) or its successor organization.
Premises: Any location, building, structure, residence, garage, room, shed, shop, store, dwelling, lot, parcel, land or portion thereof, whether improved or unimproved.
Premises Containment: The protection of a public water system’s distribution system from backflow from a user’s premises through the installation of one or more air gaps or BPAs, installed as close as practical to the user’s service connection, in a manner that isolates the water user’s water supply from the public water system’s distribution system.
Responsible Party: The owner, operator, manager, or occupant of a premises which has water service from a public potable water distribution system; the owner, manager, or operator of a private water system that has water service from a public potable water distribution system.
Service Connection: The terminal end of a tie-in to the public potable water system; i.e., the location where the City of Santa Maria loses jurisdiction and sanitary control over the water. If a meter is installed at the end of the service connection, then the service connection generally means the downstream end of the meter.
Service Line: Private piping extending from the service connection to the responsible party's point(s) of use.
Water System: The piping and all related appurtenances providing potable water to a premises. In the City of Santa Maria, the water system is made up of two parts:
1. The City Distribution System includes all facilities and the network of conduits used for the delivery of water that are under the control of the City up to the point where the Responsible Party System begins.
2. The Responsible Party Water System includes those parts used for the delivery of water to points of use located on the Responsible Party System premises beyond the termination of the City Distribution System.
Attachment C
Cross-Connection Control Program Introduction
City of Santa Maria Regulatory Review - 12/30/2025
Cross-Connection Control Plan 8
City of Santa Maria Cross-Connection Control Program
The City of Santa Maria operates PWS CA4210011 and has the responsibility to protect the public water supply through implementation and enforcement of a CCC Program.
Program Requirements
In conformance with the CCCPH, the City of Santa Maria CCC Program includes the following elements.
• Santa Maria Municipal Code and the relevant operati
ng rules and ordinances.
• City Standards.
• Designated cross-connection control program coordin ator. • This Cross-Connection Control Plan.
Processes and procedures for hazard assessments.
Backflow prevention requirements.
Requirements to rely upon certified backflow prevention assembly testers and certified cross-connection control specialists.
Establishing, documenting, and enforcing backflow prevention assembly testing requirements.
Recordkeeping.
Backflow incident response, reporting, and notification. Public outreach and education.
Local entity coordination.
Program Goals
The stated primary objective (goal) of the Cross-Connection Control Policy Handbook (CCCPH) is:
“The protection of public health through the establishment of standards intended to ensure a PWS’s (Public Water System’s) drinking water distribution system will not be subject to the backflow of liquids, gases, or other substances. In addition, by providing basic educational information on backflow prevention, the State Water Resources Control Board (State Water Board) intends to build a foundation of awareness within the regulated community regarding the importance of backflow protection and cross-connection control, leading to the implementation of a robust cross-connection control program for PWSs.”
The primary goal of the City of Santa Maria is to protect the City Distribution System from contamination or pollution by way of backflow into the system. The City will use the following actions to achieve this goal.
• Promote the elimination or control of existing cros
s-connections, actual or
potential, between the City distribution system and the Responsible Party's water system.
Attachment C
Cross-Connection Control Program Introduction
City of Santa Maria Regulatory Review - 12/30/2025
Cross-Connection Control Plan 9
• Isolate the Responsible Party’s water system using an appropriate backflow prevention assembly when reasonable hazards exist which could backflow and introduce contamination or pollution into the City distribution system. • Regularly update and enforce a CCC Program which wi ll systematically and effectively prevent the contamination or pollution of the City distribution system.
This Cross-Connection Control Plan is one aspect of the CCC Program. • Provide outreach and education on cross-connections
to the community, water
customers, and City staff.
City of Santa Maria Cross-Connection Control Plan
Through the CCC Program, the City will implement a CCC Plan and ensure that its CCC Plan represents the current operation of its CCC Program. Substantive revisions to the City’s CCC Plan will be submitted to the State Water Board for review.
Operating Rules or Ordinances
The City has adopted Santa Maria Municipal Code Chapter 8-10A Cross-Connections; which authorizes the City to implement a CCC Program. The ordinance authorizes the City to terminate water service, issue citations for Responsible Parties that do not comply with the ordinance, and to protect the public water distribution system in a manner the City deems appropriate.
Other Titles and Chapters of the Santa Maria Municipal Code will apply to buildings and development and are a part of the Cross-Connection Control Program, such as Chapter 8-10 Water Service and Chapter 9-32 Plumbing Code. The Cross-Connection Control Plan is supplemental to the Santa Maria Municipal Code, and both are a part of the Cross-Connection Control Program.
City Standards
The City maintains and publishes Standard Specifications and Drawings (City Standards) to guide engineering and development within City limits. The City Standards include standards that govern the water system including installation of backflow prevention assemblies. The City Standards supplement the Cross-Connection Control Plan and form a part of the Cross-Connection Control Program.
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Attachment C
Cross-Connection Control Program Introduction
City of Santa Maria Regulatory Review - 12/30/2025
Cross-Connection Control Plan 10
Cross-Connection Control Program Coordinator
The City has designated the following individual for monitoring, tracking, and other administrative duties.
Due to the number of service connections, the City will employ a permanent or contracted Cross-Connection Control Specialist to fill the role of Cross-Connection Control Program Coordinator. The City will ensure that the employed individual is able to be contacted within one hour. The following table identifies the current certified specialist employed or retained on contract by the City to manage the City’s CCC Program and/or act as the cross-connection control technical resource for the City:
Name of Designated Certified Cross-
Connection Control Specialist John Maxson
Address 601 Black Rd, Santa Maria
Email [email protected]
Phone Number (805) 925-0951 *7260
Specialist Certification Number and
Certifying Organization ABPA S05-729
Name of CCC Program Coordinator Same
Name of 24-hour CCC Contact (can be the
CCC Specialist or a designee)
(24-hour phone number will go to on-call
individual)
Title (if not the CCC Specialist) Water Operator
24-hour Phone Number (805) 249-0038
The following cross-connection related tasks will be performed by or under the direction of the City’s certified CCC Program Coordinator.
• Preparation of and recommendations regarding change s to the CCC program. • Performance of and/or review and approval of cross- connection control hazard assessments.
• Establish minimum requirement on the type of BPAs t o be installed. • Provide recommendations on schedules for retrofitti ng of BPAs. • Assist with enforcement of violations of the CCC Pr ogram. • Conduct inspections of BPAs for proper application, installation, and compliance.
• Review BPA inspection and test reports (may also be performed by a certified BPA tester).
• Provide recommendations or the granting of exceptio ns to mandatory premises Attachment C
Cross-Connection Control Program Introduction
City of Santa Maria Regulatory Review - 12/30/2025
Cross-Connection Control Plan 11
containment (protection at the service connection).
• Conduct or assist City staff in the investigation o f backflow incidents and other water quality problems.
• Completion of Backflow Incident Reports.
• Completion or review and approval of Cross-Connecti on Control Annual Reports and any other deliverables required by the State Water Board.
The City may delegate other CCC Program activities to other personnel who are not certified cross-connection control specialists. These activities may include the following:
• Mailing, including e-mail and other electronic comm unication, collecting, and initial screening of hazard assessments.
• Mailing, including e-mail and other electronic comm unication, of BPA testing and non-compliance notices.
• Receiving and screening assembly testing reports.
• CCC Program database administration and recordkeepi ng. • Distribution of public education and outreach mater ial. • Assisting with local entity coordination.
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Attachment C
Cross-Connection Control Program Introduction
City of Santa Maria Regulatory Review - 12/30/2025
Cross-Connection Control Plan 12
Cross-Connection Hazard Survey Schedule for Initial
Hazard Assessments
The schedule for initial hazard assessment is outlined in the following table. The schedule starts from the date the CCC Program is established (no later than July 1, 2025).
Initial Assessment Task
Estimated number
to be completed
per year
Estimated
Completion Date
Hazard assessment of new connections will be done prior to initiating water service
500
Ongoing
Hazard assessment of high-hazard non-residential service connections which are listed on Appendix D of the CCCPH 2031
Hazard assessment of non-high hazard non-residential
service connections 2031
Hazard assessment of residential service connections with special plumbing facilities or auxiliary water use 2071 Hazard assessment of all other residential service
connections 2071
Fire Protection System BPA assessment and installation July 1, 2034 (see note below)
There are approximately 2,911 commercial, industrial, landscape, and other connections within the City Distribution System. Estimating a completion of 500 hazard assessments per year, it will take approximately 6 years to complete high hazard and non-high hazard assessments for non-residential connections. Commercial, industrial, landscape, and high hazard assessments will take precedence over single family and multi-family hazard assessments.
There are approximately 20,077 single family and multi-family connections within the City. Estimating that 500 hazard assessments are completed per year, it will take approximately 40 years, after completion of the non-residential assessments, to complete hazard assessments for single family and multi-family connections
1. Known fire sprinkler connections will require installation of a BPA or confirmation of a currently installed and properly maintained BPA by July 1, 2034. All unprotected fire connections discovered through hazard assessments will require the installation of a BPA within 90 days for high hazard connections or 180 days for non-high hazard connections following the above schedule.
1 Hazard assessments for residential connections will be prioritized based on factors like construction year or presence of a swimming pool or private well. Since January 2011, when residential fire sprinkler standards were adopted, 878 multi-family and 1,521 single-family permits have been processed, totaling 2,399 premises. These 2,399 premises will be assessed by July 1, 2034. DWR GIS Map will be used to help determine the presence of a private well.
Attachment C
Element 1 – Hazard Assessments
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Cross-Connection Control Plan 13
Element 1 – Hazard Assessments
The City will conduct a hazard assessment of the Responsible Party premises within its service area to evaluate the potential for backflow into the City distribution system. The hazard assessment will consider the items listed below. • The existence of cross-connections.
• The type and use of materials handled and present,
or likely to be, on the user
premises.
• The degree of piping system complexity and accessib ility. • Access to auxiliary water supplies, pumping systems , or pressure systems. • Distribution system conditions that increase the li kelihood of a backflow event (e.g., hydraulic gradient differences impacted by main breaks and high-water demand situations, multiple service connections that may result in flow-through conditions).
• User premises accessibility.
• Any previous backflow incidents on the user premise
s.
• The requirements and information provided in the CC CPH and the City of Santa Maria CCC Plan.
The procedures for conducting a hazard assessment, initial and subsequent, are in the following sections.
New Water Connections
City staff will review records on file and/or building permit applications when performing hazard assessment.
Commercial, Industrial, and Landscape Service Connections For commercial, industrial, or landscape service connections, the City may use any of the following list.
• City staff will review records on file and/or build
ing permit applications for
hazard assessment.
• City staff will conduct an onsite assessment or a s ite survey for hazard identification.
• Require the water user to submit to the City a haza rd assessment (at the Responsible Party’s expense) by a City approved certified cross-connection control specialist.
• City review of hazard assessments previously conduc
ted at the user premises.
Agricultural Service Connections
No agricultural service connections exist within City service area. The City will monitor requests for any new agricultural service connections and may utilize the hazard assessment procedure(s) noted in the Commercial, Industrial and Landscape Service Attachment C
Element 1 – Hazard Assessments
City of Santa Maria Regulatory Review - 12/30/2025
Cross-Connection Control Plan 14
Connections section.
Single Family and Multi-Family Residential Service Connections For single family and multi-family service connections, the City may use any of the following list.
• City staff will review records on file and/or build ing permit applications for hazard assessment.
• City staff will conduct an onsite assessment or a s ite survey for hazard identification.
• Require the Responsible Party to submit to the City , a completed “Water Use Questionnaire,” which will be used for hazard assessment. (A copy of the “Water Use Questionnaire” is included as an attachment to this Plan). • Require the Responsible Party to submit to the City
, a hazard assessment (at
the Responsible Party’s expense) by a City approved certified cross-connection control specialist.
• City review of hazard assessments previously conduc
ted at the user premises.
Temporary Service Connections
City staff will review temporary connection applications for hazard identification.
Subsequent Hazard Assessments
Subsequent to the initial hazard assessment, the City will perform a hazard assessment if any of the following events occur.
• If a user premises changes account holder, excludin
g single-family residences.
• If a user premises is newly or re-connected to the City. • If evidence exists of changes in the activities or materials on a user’s premises. • If backflow from a user’s premises occurs.
• Periodically, as identified in the City’s CCC Plan required pursuant to CCCPH. • If the State Water Board requests a hazard assessme nt of a user’s premises. • If the City concludes an existing hazard assessment may no longer accurately represent the degree of hazard.
Subsequent hazard assessments will follow the procedures listed above.
Inspection of Internal Protection at City-Owned Water Supply Treatment and Storage Facilities
The City’s Blending and Disinfection Facility, Well Sites, and Water Storage Reservoirs will receive a cross-connection survey annually to assess the need for internal protection and to document the status and presence of internal protection from internal cross-connections. The City will routinely (twice per year) inspect non-testable devices as identified in the annual survey to verify the device is operating properly.
Attachment C
Element 2 – Prevention of Contamination
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Cross-Connection Control Plan 15
Element 2 – Prevention of Contamination
The Responsible Party’s plumbing system, generally starting from the termination of the City meter, is considered a potential high-health hazard requiring the isolation of the Responsible Party’s premises by an approved, Responsible Party-installed, owned, and maintained backflow prevention assembly (BPA) (e.g., reduced-pressure principle backflow prevention assembly (RP) or reduced-pressure detector assembly (RPDA)).
The BPA must be located at the end of the PWS water service pipe (i.e., as close as practical to the Responsible Party side of the meter). Water will only be supplied to the Responsible Party through an approved, Responsible Party-installed, and maintained BPA.
No water service connection to any premises will be installed or maintained by the City unless the water supply is protected as required by City rules and regulations.
Service of water to any premises will be discontinued by the City if a required backflow prevention assembly is not installed, tested and maintained, or if it is found that a backflow prevention assembly has been removed, bypassed, or if an unprotected cross- connection exists on the premises. Service will not be restored until such conditions or defects are corrected.
The Responsible Party’s system must be open for inspection at all reasonable times to authorized representatives of the City to determine whether unprotected cross- connections or other structural or sanitary hazards, including violations of the CCC Plan or other regulations, exist. When such a condition becomes known, the City shall deny or immediately discontinue service to the premises until the Responsible Party has corrected the condition(s) in conformance with the City CCC Program.
The City, upon an assessment of the risk of contamination posed by the Responsible Party’s plumbing system and use of water, may allow a single-family residential premises to connect to the Distribution System without a City-approved backflow prevention assembly.
Conditions for Service
By agreeing to start utility services, the Responsible Party agrees to comply with all regulations pertaining to such services pursuant to requirements in the City of Santa Maria Municipal Code and the following conditions for service. • The Responsible Party agrees to take all measures n
ecessary to prevent
contamination of the plumbing system within their premises and the City Distribution System that may occur from backflow through a cross-connection.
These measures must include the prevention of backflow under any backpressure or backsiphonage condition, including during a disruption of water supply from the City's system that may occur during routine system maintenance or during emergency conditions, such as a water main break. • The Responsible Party agrees to install, operate, a
nd maintain their plumbing
Attachment C
Element 2 – Prevention of Contamination
City of Santa Maria Regulatory Review - 12/30/2025
Cross-Connection Control Plan 16
system in compliance with the current edition of the California Plumbing Code (CPC), City standards, and the Santa Maria Municipal Code. • For cross-connection control or other public health -related surveys, the Responsible Party agrees to provide access to all parts of the premises during reasonable working hours for the City employees or agents to provide routine surveys.
• The Responsible Party agrees to provide access to a
ll parts of the premises at
all times during emergencies.
• The Responsible Party agrees to bear all costs for the installation, testing, repair, maintenance, and replacement of the Responsible Party’s backflow prevention assembly.
• If required by the City, the Responsible Party agre
es to submit, to the City,
plumbing plans and/or a cross-connection control survey of the premises conducted by a City-approved and certified Cross-Connection Control Specialist. The cost of the survey will be borne by the Responsible Party. • The Responsible Party agrees to complete and submit
, to the City, a "Water
Use Questionnaire" for the purpose of surveying the health hazard posed by the Responsible Party's plumbing system to the City Distribution System. • The Responsible Party agrees to obtain prior approv
al from the City for
changes in water use, alterations, and additions to the plumbing system that may increase the contamination risk to the City Distribution System. The Responsible Party agrees to comply with any additional requirements imposed by the City for cross-connection control.
• The Responsible Party agrees to immediately notify
the City and the local
health jurisdiction of any backflow incident or possibility of backflow incident occurring at the Responsible Party’s premises (i.e., entry of any contaminant/pollutant into the drinking water) and shall cooperate fully with the City to determine the reason for the backflow incident. • The Responsible Party acknowledges the right of the
City to discontinue the
water supply within 72 hours of giving notice to the Responsible Party, or a lesser period of time if required to protect public health, if the Responsible Party fails to cooperate with the City in the survey of premises, in the installation, maintenance, repair, inspection, or testing of backflow prevention assemblies or air gaps required by the City, or in the City's effort to contain a contaminant or pollutant that is detected in the Responsible Party's system. • The Responsible Party acknowledges and agrees to co
mply with the right of
the City, in keeping with changes to California State regulations, industry standards, or the City's risk management policies, to impose retroactive requirements for additional cross-connection control measures. • The SWRCB, and City may, at their discretion, requi
re a water user to
designate a User Supervisor when the user premises has a multi-piping system that conveys various types of fluids and where changes in the piping system are frequently made.
Attachment C
Element 2 – Prevention of Contamination
City of Santa Maria Regulatory Review - 12/30/2025
Cross-Connection Control Plan 17
Backflow Prevention Assembly Determination
The City will ensure that actual and potential cross-connections are eliminated when possible or controlled by the installation of approved BPAs or air gaps (AG) consistent with the requirements of the CCCPH.
Existing Backflow Prevention Assemblies
All presently installed BPAs which do not meet the requirements of the CCC Program but which were approved assemblies for the purposes described at the time of installation and which have been properly maintained, are, except for the field testing and maintenance requirements, excluded from the requirements of these rules so long as the City is satisfied that the installed BPA will adequately protect the City Distribution System.
Whenever an existing BPA is moved from its present location, is in need of major repair or when the City finds that the maintenance constitutes a hazard to health, the Responsible Party will replace the existing BPA with an approved backflow prevention assembly meeting the CCC Program requirements. Nothing herein relieves the Responsible Party from obligations to alter the BPA based on a change of use or a hazard assessment.
Requirements
• The City will require that all new, non-residential , water service connections be isolated with an RP. All service connections identified as high hazard or identified in Appendix D of the CCCPH shall be isolated with an RP or AG as appropriate.
• The City will require that existing, non-residentia
l, water service connections
identified as a high hazard through hazard assessment be isolated with an RP.
All service connections identified as high hazard or identified in Appendix D of the CCCPH must be isolated with an RP or AG as appropriate. • The City will require all new residential water con nections with facilities identified as high hazard or identified in Appendix D of the CCCPH be isolated with an RP. All BPA requirements for existing residential connections will depend on the outcome of a hazard assessment.
• The City will require that all new, non-residential
, water service connections
with metered fire protection systems be isolated with an RP and unmetered fire protection systems be isolated with an RPDA
2. • The City will require that all existing, non-reside ntial, water service connections with fire protection systems be isolated with a DCDA2 or RPDA within 10 years of the effective date of the CCCPH.
• The City will require all high hazard fire protecti on systems, including but not limited to, fire protection systems that have the potential to utilize chemical addition (e.g., wetting agents, foam, anti-freeze, corrosion inhibitor) or an auxiliary water supply, be isolated with a RP or RPDA by July 1, 2034.
2 Detector assembly not required if system is metered.
Attachment C
Element 2 – Prevention of Contamination
City of Santa Maria Regulatory Review - 12/30/2025
Cross-Connection Control Plan 18
The City of Santa Maria Fire Department does not use firefighting foams or other chemical additives in fire apparatus water tanks or for injection into fire sprinkler system Fire Department Connections (FDCs). The City will continue to monitor fire department activities and procedures regarding use of firefighting foams or chemical additives. The City will utilize hazard assessments for determination if an FDC is within 1,700 feet of an auxiliary non-potable water source. If an auxiliary non-potable water source is present, an RP or RPDA will be required for fire services with an FDC.
Existing DCDAs, in which a FDC is present, and which do not trigger high hazard premises containment, can remain in place until they are in need of major repair or are no longer an approved BPA per the USC List of Approved Backflow Prevention Assemblies.
• The City will require all residential connections w
ith fire protection systems to
be isolated with a DC or RP within 10 years of the effective date of the CCCPH. Residential connections with fire protection systems capable of meeting all the following criteria will not be required to install a BPA. ° The residential premises has only one service conne ction to the Distribution System.
° A single service line onto the residential premises exists that subsequently splits on the property for domestic flow and fire protection system flow, such that the fire protection system may be isolated from the rest of the user premises.
° A single, water industry standard, water meter is p
rovided to
measure combined domestic flow and fire protection system flow. ° The fire protection system is constructed of piping materials certified as meeting NSF/ANSI Standard 61.
° The fire protection system’s piping is looped withi n the structure and is connected to one or more routinely used fixtures (such as a water closet) to prevent stagnant water.
• The City will require temporary water connections t
o be equipped with an RP.
• The required premises containment shall be purchase d, installed, tested, inspected, and maintained at the Responsible Party’s expense in accordance with City standards, Santa Maria Municipal Code, and the CCC Program.
Additional Premises Requiring Premises Containment
The following list includes premises and activities requiring backflow protection with level indicated.
• Any multi-family premises
3 – RP.
• Any premises with piping for livestock – RP.
• Any premises/activity as determined by the Director of Utilities to present a hazard to the PWS – RP.
3 The determination of a multi-family premise will be made by the Director of Utilities.
Attachment C
Element 2 – Prevention of Contamination
City of Santa Maria Regulatory Review - 12/30/2025
Cross-Connection Control Plan 19
Backflow Prevention Assembly Requirements
The City will require that all backflow prevention assemblies be approved through both laboratory and field evaluation tests performed in accordance with standards found in the Manual of Cross-Connection Control, Tenth Edition, or any successor edition, published by the University of Southern California Foundation for Cross-Connection Control and Hydraulic Research.
Installation Criteria for Backflow Protection
Each BPA and AG separation must be accessible for field testing, inspection, and maintenance.
Installation Requirements
BPA Installation Requirements are as follows.
• As close as practical to the water service connecti on. Exceptions require approval on a case-by-case basis.
• Installed in the orientation for which they are app roved. • Installed in a manner and location that facilitates their proper orientation, maintenance, and testing or inspection.
• Installed in a manner that will protect them from w eather related conditions such as flooding and freezing.
• Installed in compliance with applicable safety regu lations. • In no case shall a cut, tee, or tap be made between the Responsible Party’s point of connection to the City distribution system and the backflow prevention assembly intended for premises containment.
• RP assemblies shall be installed with a minimum sid
e clearance of twelve
inches, except that a minimum side clearance of twenty-four inches must be provided on the side of the assembly that contains the test cocks. City may approve alternate clearances provided that there is adequate clearance for field testing and maintenance.
• No post-manufacture modifications to backflow preve
ntion assemblies shall be
accepted.
• Installed in accordance with the installation stand ards outlined in the most recently published edition of the CCCPH, or University of Southern California Foundation for Cross-Connection Control and Hydraulic Research (USCFCCCHR) Manual of Cross-Connection Control.
• Installations shall conform to standard drawings an
d specifications of the City.
Air Gap Requirements
• The receiving water container must be located on th e Responsible Party’s premises at the Responsible Party’s service connection unless an alternate location has been approved by the City.
• All piping between the Responsible Party’s service
connection and the
discharge location of the receiving water container must be above finished Attachment C
Element 2 – Prevention of Contamination
City of Santa Maria Regulatory Review - 12/30/2025
Cross-Connection Control Plan 20
grade and be accessible for visual inspection unless an alternative piping configuration is approved by the City.
• The City will inspect the installed AG to ensure th at the AG has been installed as required by City standards, Santa Maria Municipal Code, and the CCC Program.
• Any new AG installation at a Responsible Party’s se
rvice connection must be
reviewed and approved by the State Water Board prior to installation.
Schedule for Installation of BPAs
The following table shows the schedule that the City will follow for installation of BPAs when required (based on the hazard assessment).
The City may consider granting an extension of 30 days for installation of BPA for an existing connection if requested by the premises owner.
Type of Service Schedule
New connections with identified hazards Before water service is initiated Existing connections with Appendix D-type hazards and
other high hazard cross-connection potential Within 90 days after notification Existing high hazard fire protection systems Within 90 days after notification Existing non high hazard fire protection systems Within 180 days after notification Enforcement
When the Responsible Party fails to install the required backflow protection within 30 days after the due date specified, the City will send a second notice giving the Responsible Party an additional 30 days to comply. The notice will also inform the Responsible Party that failure to satisfactorily respond to this notice will result in penalties in accordance with Element 5 of this Cross-Connection Control Plan and Chapter 8-10A Cross-Connections of the Santa Maria Municipal Code. Penalties can include fines or disconnection of water service or both.
(This space is intentionally blank.)
Attachment C
Element 3 – Certified BPA Testers and Certified CCC Specialists City of Santa Maria Regulatory Review - 12/30/2025
Cross-Connection Control Plan 21
Element 3 – Certified BPA Testers and Certified CCC
Specialists
All BPA testers and cross-connection control specialists performing work in the City’s service area must be certified per requirements of the CCCPH, City standards, Santa Maria Municipal Code, and the CCC Program (this Cross-Connection Control Plan is a component of the CCC Program).
Backflow Incident Reporting Obligations of BPA Testers
The City requires backflow prevention assembly testers to notify the City as soon as possible, and within 24 hours, if a backflow incident or an unprotected cross-connection is observed at the BPA or prior to the Responsible Party premises during field testing.
The City will require backflow prevention assembly testers to notify the City if a Responsible Party, or City owned BPA is observed to have been modified from its original approval.
Pre-Approved Lists
Certified BPA Testers and Cross-Connection Control Specialists must be included on the City’s pre-approved list to provide testing in the City’s service area. Application must be made to the Utilities Department on forms provided, which will include but not be limited to the following:
• Evidence of current certification, as recognized in
the CCCPH, in good
standing.
• Make, model, and serial number of field-testing equ ipment (BPA Testers only). • Evidence of test equipment verification of accuracy and/or calibration within the past 12 months (BPA Testers only).
• Evidence of a current City Business License.
T
he Utilities Department will maintain a list of certified BPA Testers and Cross- Connection Control Specialists that have been pre-approved. The lists will be revised as necessary.
Denial, Suspension or Revocation of BPA Tester or Cross-Connection Control Specialist Approval
BPA Tester/Cross-Connection Control Specialist Approval by the City may be denied, suspended, or revoked for any of the following reasons:
• A BPA Tester is no longer in possession of a curren t and valid certificate as a Backflow Prevention Assembly Tester issued by the approved certification entity as determined by the City.
• A BPA Tester is no longer in possession of a curren t and valid test kit Attachment C
Element 3 – Certified BPA Testers and Certified CCC Specialists City of Santa Maria Regulatory Review - 12/30/2025
Cross-Connection Control Plan 22
calibration certificate.
• A Cross-Connection Control Specialist is no longer in possession of a current and valid certificate as a Cross-Connection Control Specialist issued by the certification entity as determined by City.
• The City determines that a material misrepresentati on was included or omitted by the BPA Tester or Cross-Connection Control Specialist on the initial or renewal application for BPA Tester or Cross-Connection Control Specialist certification.
• The City determines that the BPA Tester, in the per
formance of a test or repair
required by the City, commits an act that may pose a threat to public health and safety.
• A BPA Tester repeatedly submits incomplete or incor
rect test reports to the
City.
• A BPA Tester fails to report an assembly that has b een modified or incorrectly installed.
• The City determines that a material misrepresentati on was included or omitted by the BPA Tester on the backflow assembly test report form submitted to the City by the BPA Tester.
• A BPA Tester performs a backflow prevention assembl
y repair with parts other
than OEM parts.
• A BPA Tester performs a backflow assembly test usin g testing procedures other than those accepted by the City.
• A BPA Tester or Cross-Connection Control Specialist fails to report a cross- connection hazard that is unprotected, that is, with no backflow prevention assembly or the wrong type of assembly.
• A BPA Tester fails to report the removal or replace
ment of a backflow
prevention assembly on a Backflow Prevention Assembly Test Report. • A BPA Tester performs a repair upon a backflow prev ention assembly which has been required to be replaced by the City.
• If a BPA Tester or Cross-Connection Control Special ist has unresolved Responsible Party complaints or complaints from multiple Responsible Parties. • If a BPA Tester or Cross-Connection Control Special ist commits fraud or gross negligence in the performing of their duties.
• If a BPA Tester or Cross-Connection Control Special ist is removed for cause from another water agency’s list of approved BPA Testers or Cross-Connection Control Specialists.
• Does not possess a current City Business License.
T
he City may deny, suspend, or revoke a BPA Tester or Cross-Connection Control Specialist approval for a period between five (5) days and one year, at the discretion of the Director of Utilities.
Appeals
• Any Denial, Suspension, or Revocation of BPA Tester or Cross-Connection Control Specialist Approval is appealable pursuant to Santa Maria Municipal Attachment C
Element 3 – Certified BPA Testers and Certified CCC Specialists City of Santa Maria Regulatory Review - 12/30/2025
Cross-Connection Control Plan 23
Code Chapter 8-1.07.
• An appeal must be received by the City on or before the effective date of suspension or revocation.
• The decision shall be a final decision, with no fur ther right of appeal.
Quality Assurance
• The City shall provide follow-up on deficient backf low assemblies or test reports.
• The City may conduct follow up tests on backflow as semblies tested by a BPA Tester at the discretion of the City.
• The City will report incidents of fraud or gross in competence on the part of any certified tester to the certifying organization.
(This space is intentionally blank.)
Attachment C
Element 4 – Backflow Prevention Assembly Testing
City of Santa Maria Regulatory Review - 12/30/2025
Cross-Connection Control Plan 24
Element 4 – Backflow Prevention Assembly Testing
The following procedure will ensure all BPAs are field tested, inspected, and maintained and that AGs are inspected and maintained in accordance with the CCCPH, City standards, Santa Maria Municipal Code, and the CCC Program.
Inspection and Testing of Backflow Preventers and Air Gaps All BPAs relied upon for protection of the City distribution system will be subject to inspection and testing as applicable. This includes BPAs installed for internal protection within a user’s premises. The City must have access to the premises to verify that the on-site protection meets the requirements of the CCCPH, City standards, Santa Maria Municipal Code, and the CCC Program for installation, field testing, and inspections.
BPAs
• A certified and City approved Cross-Connection Cont rol Specialist will inspect BPAs for proper application (i.e., to ensure that the installed BPA is commensurate with the assessed degree of hazard).
• A City approved certified Cross-Connection Control
Specialist or BPA Tester
will perform inspections of backflow preventers for correct installation. • A certified and City approved BPA Tester will test all assemblies.
Air Gaps
• The City approved and certified Cross-Connection Co ntrol Specialist or BPA Tester will visually inspect AG separations at Responsible Party premises when hired to do so to determine compliance.
Frequency of Inspection and Testing
Inspection and testing of BPAs and/or AGs will be conducted at the following times. • At the time of installation.
• Annually (approximately 12 months) or more frequent ly after installation. • After a backflow incident.
• After BPA repair, reinstallation, relocation, or re -plumbing.
All AG separations will be inspected annually and after modifications to the installation.
The City may require a BPA or AG to be inspected and/or tested more frequently than once a year.
Attachment C
Element 4 – Backflow Prevention Assembly Testing
City of Santa Maria Regulatory Review - 12/30/2025
Cross-Connection Control Plan 25
Responsibility for Inspection and Testing
The City will be responsible for inspection and testing of City owned BPAs and AGs.
The Responsible Party is responsible for hiring a City approved certified BPA Tester or Cross-Connection Control Specialist for inspection and testing of BPAs. Testing and inspection of Responsible Party BPAs will be at the Responsible Party's expense.
Notification of Inspection and/or Testing
The City will notify the Responsible Party to have their BPA(s) inspected and/or tested.
Notices will be sent out not less than 30 days before the due date of the inspection and/or test and will be via a hardcopy letter sent via mail or using electronic communications. The notice will also specify the date by which the inspection or test report must be received by the City. If the City has not received a passed test report in the designated time frame, enforcement policies will be applied.
Approved Test Procedures
The City requires all BPAs protecting the City’s public water system be tested at least annually in accordance with approved test procedures as specified in CCCPH (Manual of Cross-Connection Control, Tenth Edition, or any successor edition, published by the University of Southern California Foundation for Cross- Connection Control and Hydraulic Research).
Repairs
Any BPA that fails routine testing shall be repaired within thirty (30) days of the initial test date. The cost will be borne by the Responsible Party.
The Responsible Party must notify the City if repairs cannot be made within the specified period.
Only Original Equipment Manufacturer (OEM) parts will be used to repair BPAs. If OEM replacement parts are not available, then a replacement approved backflow prevention assembly must be installed to replace the existing assembly.
The City shall determine the level of risk the failed assembly presents to the water supply and, if necessary, discontinue water service.
Should repair costs exceed $500.00, or if the assembly must be replaced, such work must be completed by a California State Licensed Contractor.
Attachment C
Element 5 – Enforcement
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Cross-Connection Control Plan 26
Element 5 – Enforcement
Conditions for Disconnection
To enforce this CCC Plan, it may become necessary to discontinue water service through connection(s) to the premises, or premises under common control. Conditions that warrant discontinuance of service include, but are not limited to, the following. • The City identifies a water use that represents a c
lear and immediate hazard to
the City Distribution System that cannot be immediately abated. • Direct or indirect connection between the City Dist ribution System and a sewer line.
• An unprotected direct or indirect connection betwee n the City Distribution System and an auxiliary water system.
• The Responsible Party refuses to inspect an AG sepa ration. • The Responsible Party refuses to install a required BPA. • The Responsible Party refuses to test a BPA.
• The Responsible Party refuses to repair or replace a faulty BPA. • The Responsible Party refuses to upgrade a BPA to t he necessary level of protection.
• The Responsible Party refuses to comply with the re quirements set forth in the CCC Plan.
Annual Testing Conditions for Disconnection
When a Responsible Party fails to submit the Annual Test and Maintenance Report within 30 days after the established due date and the City has not approved an extension to the due date, the City will take the following enforcement actions. • The City will send a second notice notifying the Re
sponsible Party of the past
due test(s). The notice will also inform the Responsible Party that failure to satisfactorily respond to this notice will result in the enforcement of penalties in accordance with the legal authority of the City.
• If the Responsible Party has not responded satisfac
torily to the City within 30
days of the second notice, the City will implement penalties in accordance with its legal authority. If the Responsible Party’s water service is discontinued due to violations of this Program, the Responsible Party will be subject to payment of the Delinquency Shut Off Fee specified in the City’s current rates. Upon seeking renewed service from the City, the backflow prevention assembly being returned to service must be tested in accordance with City requirements.
When a Responsible Party fails to submit an Annual Test and Maintenance Report showing the repairs and/or replacement of a BPA that failed a test within 30 days after the initial test date indicated on the test form, and the City has not approved an extension to the due date, the City will take the following enforcement actions.
Attachment C
Element 5 – Enforcement
City of Santa Maria Regulatory Review - 12/30/2025
Cross-Connection Control Plan 27
• The City will send a second notice notifying the Re sponsible Party of the past due test(s). The notice will also inform the Responsible Party that failure to satisfactorily respond to this notice will result in the enforcement of penalties in accordance with the legal authority of the City.
• If the Responsible Party has not submitted the pass
ing inspection/test report
within 30 days of the due date given in the second notice, the City will implement penalties in accordance with its legal authority. If the Responsible Party’s water service is discontinued due to violations of this Program, the Responsible Party shall be subject to Delinquency Shut Off Fee specified in the City’s current rates. Upon seeking renewed service from the City, the backflow prevention assembly being returned to service must be tested in accordance with City requirements.
Nothing in this section inhibits the City’s ability to discontinue water service to protect the City’s Distribution System in addition to the remedies identified in this section.
Removal of BPA is Grounds for Disconnection
In addition to the grounds for termination set forth in this section, the City may terminate water service to any premises if a required BPA or AG is removed, or if the City finds evidence that an installed BPA or AG has been bypassed or rendered ineffective.
Reported Backflow Incident Investigation and Disconnection The City will discontinue service to the premises if a backflow incident or likely backflow incident is reported and confirmed. Water service will not be restored to that premises until the City receives confirmation of a passing BPA field test from a certified and City approved backflow prevention assembly tester demonstrating that the installed backflow protection assembly is protecting the Distribution System.
Appeal of Enforcement Decisions
Any Enforcement Decision by the City is appealable pursuant to Santa Maria Municipal Code Chapter 8-1.07.
(This space is intentionally blank.)
Attachment C
Element 6 – Backflow Incident Response, Reporting, and Notification City of Santa Maria Regulatory Review - 12/30/2025
Cross-Connection Control Plan 28
Element 6 – Backflow Incident Response, Reporting,
and Notification
The procedures discussed in this element of the Cross-Connection Control Plan are for investigating and responding to suspected or actual backflow incidents.
Backflow Incident Response Procedure
The City will follow the incident response procedures outlined in the City of Santa Maria Backflow Incident Response Plan, see Attachment B.
Backflow Incident Response Plan
• Notification of affected service area population.
• Notification and coordination with other agencies, such as the State Water Board, and the local health jurisdiction.
• Identification of the source of backflow substance.
• Isolation of the source of backflow substance and t he affected area(s). • Mitigation measures to correct the problem.
• Application of corrective actions to prevent future backflow occurrences. • Documentation of the backflow incident investigatio n, response, and follow-up actions.
Backflow Incident Notification
State Water Board – Division of Drinking Water Contact Information District 06 – Santa Barbara
Office Phone: (805) 566-1326
Emergency Phone: (805) 440-9627
Santa Barbara County Environmental Health
Day: (805) 346-8463
Evening: (805) 315-5805
Other: (805) 346-8470
Santa Barbara Public Health Department EMS
Day: (805) 694-8301
Evening: (805) 694-8301
Attachment C
Element 7 – Recordkeeping
City of Santa Maria Regulatory Review - 12/30/2025
Cross-Connection Control Plan 29
Element 7 – Recordkeeping
The City will implement a recordkeeping system in accordance with the CCCPH. The records the City will keep are identified in the following list. The Responsible Party will have the duty to submit all records and documentation of any and all inspections, tests, repairs, renovations, rebuilds, restorations, or replacements of backflow assembly(s) to the City of Santa Maria Utilities Department.
• The two most recent hazard assessments for each use
r premises, conducted
pursuant to the CCC Program.
• The associated hazard or application, location, own er, type, manufacturer, model, size, installation date, and serial number for each BPA. • The associated hazard or application, location, own er, as-built plans for each AG installation.
• Results of all BPA field testing, AG inspection, sw ivel-ell inspections and field tests, for the previous three calendar years, including the name, test date, repair date, and certification number of the backflow prevention assembly tester for each BPA field test, AG, and swivel-ell.
• Replacement, relocation, or repairs made to BPAs fo
r the previous three
calendar years.
• The most current cross-connection tests.
• If a user supervisor is designated for a user premi ses, the City will keep record of current contact information for the user supervisor and water user, and any applicable training and qualifications as described by the CCCPH. • Descriptions and follow-up actions related to all b
ackflow incidents.
• A copy of the current contract or agreement, if any portion of the cross- connection control program is carried out under contract or agreement. • The current Cross-Connection Control Plan as requir ed in the CCCPH. • Any public outreach or education materials issued a s required in the CCCPH for the previous three calendar years.
All information will be available to the State Water Board upon request.
The City will maintain records using the following methods.
Item Method (Digital, hard copy, both, or other - describe) Hazard Assessments Digital
BPA Information Digital
Air Gap, Swivel-El Information Digital
BPA field test/ inspection reports Digital
BPA Installation, Repair,
Replacement
Digital
Attachment C
Element 7 – Recordkeeping
City of Santa Maria Regulatory Review - 12/30/2025
Cross-Connection Control Plan 30
Item Method (Digital, hard copy, both, or other - describe) Certification information of BPA
Testers and Cross-Connection
Control Specialists
Digital
Backflow Incident Documentation Digital
Current Cross-Connection Tests Digital
User Supervisors (if required) Digital (if required)
Follow-up Actions Digital
Public Outreach, Education
Materials
Both
Current Cross-Connection Control
Plan
Digital
(This space is intentionally blank.)
Attachment C
Element 8 – Public Outreach and Education
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Cross-Connection Control Plan 31
Element 8 – Public Outreach and Education
The City will implement a cross-connection control public outreach and education program that includes educating staff, Responsible Party’s, and the community about backflow protection and cross-connection control. The City may choose to implement this through a variety of methods, such as the methods listed below. • Periodic water bill inserts.
• Pamphlet distribution.
• Email.
• New customer documentation.
• Consumer Confidence Reports.
• City Website: https://www.cityofsantamaria.org
Local Entity Coordination
The City will coordinate with applicable local entities that are involved in either cross- connection control or public health protection to ensure hazard assessments can be performed, appropriate backflow protection is provided, and provide assistance in the investigation of backflow incidents. Local entities may include but are not limited to plumbing, permitting, or health officials, law enforcement, fire departments, maintenance, and public and private entities.
Local Entity Contact Name Contact Info (Phone,
email)
City of Santa Maria Fire
Department Fire Marshal (805)925-0951 *2255
City of Santa Maria Utilities
Department
Water Distribution
Supervisor
(805)925-0951 *7411
City of Santa Maria Building
Department Building Department (805)925-0951 *2241
(This space is intentionally blank.)
Attachment C
City of Santa Maria Regulatory Review – 12/30/2025
Cross-Connection Control Plan
Attachment
A
Copy of legal authority used to implement Cross-Connection Control Plan.
Attached is a Draft Ordinance to be considered by the City Council.
Attachment C
ORDINANCE NO. 2026-
AN ORDINANCE OF THE CITY COUNCIL OF THE CITY OF SANTA MARIA, CALIFORNIA, AMENDING CHAPTERS 8-10A AND CHAPTER 8-1 OF TITLE 8 OF THE
SANTA MARIA MUNICIPAL CODE CONCERNING CROSS-CONNECTIONS AND
APPLICATIONS FOR PUBLIC SERVICE
The City Council of the City of Santa Maria, State of California, does ordain as follows:
SECTION 1.
Chapter 8-10A of Title 8 of the Santa Maria Municipal Code (“SMMC”) concerning Cross-Connections is amended as follows:
Section 8-10A.01. Purpose.
(a) To protect the public Potable Water supply of the City of Santa Maria from the possibility of contamination or pollution by isolating within the Responsible Party's internal or private water system(s) such contaminants or pollutants which could Backflow into the public water distribution system; and
(b) To promote the elimination or control of existing cross-connections, actual or potential, between the Responsible Party's in-plant Potable Water system(s) and non-potable water system(s), plumbing fixtures, and industrial piping system(s); and (c) To provide for the maintenance of a continuing program of Cross-Connection control which shall systematically and effectively prevent the contamination or pollution of the publicly owned Potable Water system.
(d) To provide outreach and education on Cross-Connections to the community, water customers, and City staff.
(e) To meet the State of California’s cross-connection control program standards.
Section 8-10A.02. Definitions.
“Approved” means accepted by the Director of Utilities as meeting an applicable specification stated or cited in this ordinance, the Cross-Connection Control Plan, or as suitable for the proposed site.
“Approved Backflow Prevention Assembly” or “BPA” means a mechanical assembly designed and constructed to prevent Backflow, such that while in-line it can be maintained and its ability to prevent Backflow, as designed, can be field tested, inspected and evaluated. “Backflow” means an undesired or unintended reversal of flow of water and/or other liquids, gases, or other substances into a public water system’s distribution system or approved water supply. “Cross-Connection” means any actual, potential, or temporary connection (such as swing connections, removable sections, four-way plug valves, spools, dummy sections of pipe, swivel or change-over devices, sliding multiport tubes, or similar) or structural arrangement between the public Potable Water distribution system, including a piping system connected to the Distribution System and located on the Premises of a water user or available to the water user, and any source or system containing liquid, gas, or other substances that may enter the public Potable Water system.
Attachment C
“Cross-Connection Control Plan” or “CCC Plan” means the City’s guiding document establishing the methods, procedures, and policies the City has in place to comply with the requirements of the Cross-Connection Control Policy Handbook.
“Cross-Connection Control Policy Handbook” or “CCCPH” means the State of California cross- connection control (CCC) program standards as established in the CCCPH, which became effective July 1, 2024, and are incorporated into the State of California’s Drinking Water Regulations. The CCCPH and its standards apply to all California public water systems (PWSs), as defined in California’s Health and Safety Code (CHSC, section 116275 (h)). Compliance with this CCCPH is mandatory for all California PWSs. The CCCPH updated and replaced Title 17 of the California Code of Regulations.
“Director of Utilities” means the administrator/manager in charge of all aspects of the Utilities Department.
“Distribution System” means the network of conduits used for the delivery of Potable Water from the source to the Responsible Party's water system.
“Operational Tests” means BPA tests performed to test the functioning capabilities of the assembly using a properly calibrated differential pressure gauge and performed as published in the Manual of Cross-Connection Control – Tenth Edition, or any successor edition. “Potable Water” means water which is satisfactory for drinking, culinary, and domestic purposes and meets the requirements of the United States Environmental Protection Agency (USEPA) or its successor organization.
“Premises” means any location, building, structure, residence, garage, room, shed, shop, store, dwelling, lot, parcel, land or portion thereof, whether improved or unimproved. “Responsible Party” means the owner, operator, manager or occupant of a Premises which has water service from a public Potable Water distribution system; the owner, manager or operator of a private water system that has water service from a public Potable Water distribution system. “Service Connection” means the terminal end of a tie-in to the public Potable Water system; i.e., the location where the City of Santa Maria loses jurisdiction and sanitary control over the water.
If a City-owned meter is installed at the end of the tie-in to the public Potable Water system, then the Service Connection generally means the downstream end of the meter. “Service Line” means private piping extending from the Service Connection to the Responsible Party's point(s) of use.
“Water System” means the piping and all related appurtenances providing Potable Water to a Premises. In the City of Santa Maria, the water system is made up of two parts:
(1) The public Potable Water distribution system includes all the facilities and the network of conduits used for the delivery of water that remain under the control of the City of Santa Maria up to the point where the Responsible Party's system begins. (2) The Responsible Party's system includes those parts used for the delivery of water to points of use located on the responsible party's Premises beyond the termination of the public Potable Water distribution system.
Attachment C
Section 8-10A.03. Authority of Director of Utilities.
The Director of Utilities shall have the authority to prepare, amend, and enforce the Cross- Connection Control Plan to protect the public Potable Water distribution system from contamination or pollution due to the Backflow of contaminants or pollutants through the Service Connection and to comply with the Cross-Connection Control Policy Handbook.
Section 8-10A.04. Requirements.
(a) By agreeing to start or continuing to accept utility services, the Responsible Party agrees to comply with all regulations pertaining to such services pursuant to requirements in the Santa Maria Municipal Code and the Conditions for Service established in the Cross-Connection Control Plan.
(b) No Responsible Party will install, maintain, or change a Service Connection or Service Line without first complying with the CCC Plan.
Section 8-10A.05. Enforcement, Violations, and Penalties. (a) A violation of the CCCP is a violation of this ordinance. (b) A Notice of Violation will be given to any Responsible Party found to be in violation of any provision of this ordinance or the adopted CCC Plan. The Responsible Party shall correct the violation within the time frame given in the Notice of Violation. If the Director of Utilities, or his/her designee, determines that the violation is creating or contributing to the existence of an imminent hazard, the Responsible Party shall correct the violation immediately. In any case of violation, the Director of Utilities has the authority to discontinue water service at any time the Director of Utilities determines the violation causes an imminent risk to the public Potable Water distribution system or Potable Water supply. (c) Water service may be terminated after a second notification of violation of the same provision within a one-year period. Any person violating any provision of this ordinance shall pay to the City all expenses incurred by the City in repairing any damage to the public Potable Water distribution system or actions required by the City to be taken to protect the Potable Water supply caused in whole or in part by such violation and any expense incurred by the City in investigating such violation.
(d) In addition to other remedies in this ordinance, any Responsible Party violating any of the provisions herein is guilty of a misdemeanor and upon conviction thereof is punishable in accordance with Chapters 1-6 of the Santa Maria Municipal Code (SMMC). As additional remedies, any Responsible Party in violation of this code may be subject to summary abatement proceedings, restraining order, injunction issued by a court of competent jurisdiction, administrative citation pursuant to Chapter 1-9 of the SMMC, administrative penalty pursuant to Chapter 1-8 of the SMMC code, or any other remedy provided by law.
SECTION 2.
Chapter 8-1.07 of Title 8 of the Santa Maria Municipal Code (“SMMC”) concerning Cross-Connections is amended as follows:
Attachment C
Section 8-1.07 Appeals
In the event that any user or consumer is aggrieved by any ruling of the Director of Utilities made pursuant to any of the provisions of this chapter and Chapters 8-9, 8-10, 8-10A, and 8-13, such consumer or user may appeal from such ruling to the City Manager within the time and in the manner set forth in Section 8-12.1406. The City Manager's action on such appeal shall likewise be made and become final pursuant to the provisions of Section 8-12.1406.
SECTION 3.
This Ordinance has been reviewed for compliance with the California Environmental Quality Act (CEQA), and the CEQA guidelines, and the City’s environmental procedures, and has been found to be exempt pursuant to Section 15601(b)(3) (general rule) of the CEQA Guidelines, because the City Council hereby finds with certainty that there is no possibility the passage of this Ordinance amending the public facilities and services code will have a significant effect on the environment.
SECTION 4.
If any part or provision of this chapter, or the application thereof to any person or circumstance, is held invalid, the remainder of the chapter, including the application of that part or provision to other persons or circumstances, shall not be affected thereby and shall continue in full force and effect. To this end, the provisions of this ordinance are severable.
SECTION 5.
This Ordinance shall be in full force and effect 30 days after its passage. Within 15 days following its passage, the City Clerk shall cause this Ordinance to be published in a newspaper of general circulation in accordance with State Law; or when deemed necessary due to the length or complexity of the Ordinance, cause a summary of the Ordinance to be prepared and published at least five days prior to the City Council meeting at which the proposed Ordinance is to be adopted. If a summary is published at least five days prior to the City Council meeting at which the proposed Ordinance is to be adopted, then within 15 days after adoption of the Ordinance the City Clerk shall publish a summary of the Ordinance with the names of those City Council Members voting for and against the Ordinance and shall post a certified copy of the full text of such adopted Ordinance along with the names of those City Council Members voting for and against the Ordinance.
SECTION 6.
The Chief Deputy City Clerk is hereby authorized to make minor changes herein to address clerical errors, so long as substantial conformance of the intent of this document is maintained.
In doing so, the Chief Deputy City Clerk shall consult with the City Manager and City Attorney concerning any changes deemed necessary.
(This space is intentionally blank.)
Attachment C
INTRODUCED at a regular meeting of the City Council held the ___ day of ____, 2026 and PASSED AND ADOPTED the ___ day of ____, 2026 by the following roll call vote:
AYES:
NOES:
ABSENT:
ABSTAINED:
ATTEST:
Donna Schwartz
Chief Deputy City Clerk
Alice M. Patino
Mayor
APPROVED AS TO FORM:
_________________________
City Attorney
APPROVED AS TO CONTENT:
_________________________
City Manager
Attachment C
City of Santa Maria Regulatory Review – 12/30/2025
Cross-Connection Control Plan
Attachment
B
City of Santa Maria Backflow Incident Response Plan
Attachment C
Backflow Incident Response Plan
City of Santa Maria Draft – 12/30/2025
Cross-Connection Control Plan Attachment B-1
City of Santa Maria Backflow Incident Response Plan
The City will notify the State Water Board and local health agencies of any known or suspected incident of backflow within 24 hours of the determination. If required by the State Water Board, the City will issue a Tier 1 public notification pursuant to CCR, Title 22, Section 64463.1.
If required by the State Water Board, the City will submit, by a date specified by the State Water Board, a written incident report describing the details and affected area of the backflow incident, the actions taken by the City in response to the backflow incident, and the follow up actions to prevent future backflow incidents. The written report will contain, at a minimum, the information requested in Appendix F.
Backflow Incident Investigation
If a water quality complaint or change in water quality investigation determines that a backflow incident has or is suspected of having occurred, the City will initiate a backflow investigation.
Additionally, the City distribution system pressure is routinely monitored. If pressure readings indicate that a broad system pressure drop has occurred, which could produce a situation leading to a backflow or back-siphonage incident, the City will initiate a water quality investigation.
All information from the backflow incident investigation, according to Appendix F of the CCCPH, will be documented. The City will notify the State Water Board and local health agencies of any known or suspected incidents of backflow within 24 hours of determination.
State Water Board – Division of Drinking Water:
District 06 – Santa Barbara
Office: (805) 566-1326 Emergency: (805) 440-9627
Santa Barbara County Environmental Health:
Day: (805) 346-8463 Evening: (805) 315-5805
Day: (805) 346-8470 Evening: (805) 346-8470
Santa Barbara Public Health Department EMS:
Day: (805) 694-8301 Evening: (805) 694-8301
Attachment C
Backflow Incident Response Plan
City of Santa Maria Draft – 12/30/2025
Cross-Connection Control Plan Attachment B-2
Consumer Notification
• The City will notify all consumers of an upset in water quality and advise not to use or boil water prior to use, as appropriate. The City will default to AWWA recommendations for boil water advisory.
• The City will follow the City’s W ater Quality Emergency Notification Plan. Notices shall be circulated via the following manner.
o Electronic notification using the City’s “Everbridg e” text and call system or Wireless Emergency Alert
o City social media
o City webpage
o Local TV
o Local Radio
o Local News
• The notifications will be issued in both English an d Spanish. • Police and Fire Department vehicles equipped with p ortable speakers are available to traverse the City limits for further dissemination if the electronic notifications systems require backup.
• A telephone answering service will be established a
t the dispatch center to
answer questions until the City's Emergency Operations Center (EOC) can be manned and calls can be transferred to the staff there. • Notification via “Everbridge”, WEA, and social medi
a can be accomplished in a
very short time. If needed, sound trucks will take approximately two hours to traverse the entire City limits. Sound truck notification will be on a one-time basis while radio and television coverage will continue as needed.
Originating Premise Location
• The City will attempt to locate the originating premise or area prior to flushing the distribution system.
• The City will conduct a thorough investigation unti l the originating premise location of the backflow incident is identified.
• After identification, the City will work with the o riginating premise location to identify all possible contaminant sources from the backflow incident.
Premise Containment / System Containment
• After source identification, the City will verify that the backflow origination premise has been contained.
• The City will verify if any part of the distributio n system needs to be contained and contain it appropriately.
Attachment C
Backflow Incident Response Plan
City of Santa Maria Draft – 12/30/2025
Cross-Connection Control Plan Attachment B-3
Disinfection of the System
• The City will collect a water sample or samples before flushing or disinfection of the system has been initiated.
• The City will flush and/or disinfect contaminated s ervice lines. The City will default to AWWA recommendations for flushing procedures and in-house SOP procedures for disinfection.
• As appropriate, affected customers will be advised to adequately flush service lines.
Sampling Requirements
• The City will collect a water sample or samples before flushing or disinfection of the system has been initiated.
• The City will submit the water samples to a laborat ory or conduct field sampling for the following parameters (DDW recommended parameters):
o Total Coliform
o E. coli
o Free and Total Chlorine Residual
o Odor
o Turbidity
o Temperature
o Color
Corrective Actions
• After completion of the backflow incident investigation, the City will review all findings to assure appropriate backflow protection measures are implemented for the originating premise location.
Attachment C
Backflow Incident Response Plan
City of Santa Maria Draft – 12/30/2025
Cross-Connection Control Plan Attachment B-4
BACKFLOW INCIDENT REPORT FORM (Minimum Requirements)
Water System: _________________________________________________________ Water System Number: __________________________________________________ Incident Date: __________________________________________________________ Incident Time (if known): __________________________________________________ Incident Location: _______________________________________________________ How was the incident discovered? __________________________________________ Backflow Origin
Premise Location: _______________________________________________________ Address: ______________________________________________________________ Premise Contact Person: _____________________ Title: _______________________ Phone: _______________ Email: __________________________________________ Connection Type: (please check one)
Industrial Commercial Single-Family Residential Multi-Family Residential Irrigation Temporary Service Connection
Other: ______________________________________________________________ Description and source of backflow substance (please be as descriptive as possible):
______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ If available, please attach an MSDS or other chemical description form Was the backflow fluid contained within the user side? YES NO Estimated Number of Affected Persons: ______________________________________ Number and description of consumer complaints received:
______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Did any consumers report illness? Please describe.
______________________________________________________________________ ______________________________________________________________________ Attachment C
Backflow Incident Response Plan
City of Santa Maria Draft – 12/30/2025
Cross-Connection Control Plan Attachment B-5
______________________________________________________________________ If applicable, please describe the consumer notification:
______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________
INVESTIGATION
Please describe the water system investigation including time frames:
______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ What was the area system pressure? _______________________________________ Is this within typical range: YES NO Typical Pressure: _____________________ Was a sample of the water contaminated by the backflow incident collected and stored before flushing? YES NO
Please describe all sampling:
______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________
DDW recommends laboratory or field sampling for the following parameters: total coliform, E. coli, free and total chlorine residual, pH, odor, turbidity, temperature, and color. Additional sampling should be collected at the PWS and regulatory agency’s discretion.
CORRECTIVE ACTIONS
Please describe the corrective actions taken by the water system:
______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Was the chlorine residual increased after discovery of backflow incident? YES NO Attachment C
Backflow Incident Response Plan
City of Santa Maria Draft – 12/30/2025
Cross-Connection Control Plan Attachment B-6
Date of the last cross-connection control hazard assessment of the premise with the backflow incident conducted: ______________________________________________ Did the premise have backflow prevention assemblies? YES NO Date of most recent backflow prevention assembly test(s): _______________________ When was the Division of Drinking Water or Local County Health office notified? Date: __________________Time: __________ Contact Person: __________________ Was the Division or Local County Health notified within 24 hours? YES NO Other agencies or organizations contacted? __________________________________
CERTIFICATION
Name: _________________________________ Job Title: _______________________ Certification(s): _________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Please list all cross-connection control related certifications including number and expiration date
I certify that the forgoing information is true and correct to the best of my ability.
Signature: ___________________________ Date: ____________________________ Attach the following applicable documentation
• Laboratory Test Results
• Sketch of the cross-connection and modifications
• MSDS or chemical information forms if chemical haza
rd is known
• Applicable backflow assembly test reports including the most recent test before the incident
• Other relevant supporting documentation
Attachment C
City of Santa Maria Regulatory Review – 12/30/2025
Cross-Connection Control Plan
Attachment
C
City of Santa Maria Cross-Connection Control Questionnaire
Attachment C
City of Santa Maria Regulatory Review – 12/30/2025
Cross-Connection Control Plan Attachment C-1
Cross-Connection Control Questionnaire
Dear Water Customer:
State Water Resources Control Board Cross-Connection Control Policy Handbook (CCCPH) Standards and Principles for California’s Public Water Systems became e.ective July 1, 2024. The CCCPH and its standards apply to all California Public Water Systems as defined in California’s Health and Safety Code (CHSC, section 116275 (h)). Compliance with the CCCPH is mandatory for all California PWSs. The primary objective of the Cross-Connection Control Policy Handbook (CCCPH) is the protection of public health through the establishment of standards intended to ensure a public water system’s (PWSs) drinking water distribution system will not be subject to the backflow of liquids, gases, or other substances.
The CCCPH requires that each community water system conduct an initial hazard assessment on each user premise within its service area. Subsequent to the initial hazard assessment, a follow-up hazard assessment is required when certain criteria are met. To maintain compliance with the CCCPH, the City of Santa Maria is conducting a cross-connection control hazard analysis of its residential customers.
For most residential customers, there is a minimal hazard presented to the City’s drinking water system. There are, however, some residential customers who have certain activities or plumbing systems which present a higher degree of hazard to the City’s drinking water system. For these customers, the installation of a backflow prevention assembly on their water service line may be required.
Participation in this hazard analysis is mandatory. It may be returned via e-mail to utilities- [email protected] or mailed to 601 Black Rd, Santa Maria, CA 93458. I f you have any questions about the analysis or how to fill out the questionnaire, please contact me at the contact information provided below.
Important Definitions:
Backflow: an undesired or unintended reversal of flow of water and/or other liquids, gases, or other substances into a public water system’s distribution system or approved water supply.
Backflow prevention assembly: a mechanical assembly designed and constructed to prevent backflow, such that while in-line it can be maintained and its ability to prevent backflow, as designed, can be field tested, inspected and evaluated.
Sincerely,
Jay Maxson
Regulatory Compliance Specialist – Cross-Connection Control Specialist – Water Resources City of Santa Maria | Utilities Department | 601 Black Rd, Santa Maria, CA 93458 ✆: 805.925.0951 Ext: 7260 |✉: [email protected] Attachment C
City of Santa Maria Regulatory Review – 12/30/2025
Cross-Connection Control Plan Attachment C-2
Yes No
Is the premise a single family dwelling?
If Yes, proceed.
Is a backflow prevention assembly present?
A
re any of the following existing or proposed?
Connection to auxiliary water supply such as a well or cistern tank? Residential fire sprinkler system?
Is the system looped and connected to a routinely used plumbing fixture? Is the system piping constructed of materials certified as NSF/ANSI Standard 61? Pressure booster pump? (e.g., pump supplied hot water circulating system) Commercial or agricultural use?
Water treatment system? (e.g., self-regenerating water softener, RO) Swimming pool, hot tub, or water feature directly connected to water supply? Livestock activities?
Solar heating system with a direct connection to water supply? Hose bibbs?
If yes, are they protected by a nonremovable hose bibb vacuum breaker? Home-based business? (e.g. beauty salon, pet grooming, photo lab/dark room) If yes, list type: ______________________________________________________________________________ Notes:
____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ By completing this form, you are helping determine cross-connection hazard at your premise.
Please return via e-mail to [email protected] or mailed to 601 Black Rd, Santa Maria, CA 93458.
Attachment C
City of Santa Maria Regulatory Review – 12/30/2025
Cross-Connection Control Plan
Attachment
D
City of Santa Maria Hazard Assessment
Attachment C
Hazard Assessment
City of Santa Maria Regulatory Review – 12/30/2025
Cross-Connection Control Plan D-1
Hazard Assessment
Date:
Water Customer Information
Business Name:
Owner Name:
E-mail Address:
Address:
Phone:
☐ Initial Hazard Assessment ☐ Follow-Up Hazard
Assessment
Cross-Connection Control Credentials
Name:
Signature:
Cross-Connection Control Certification Training:
Cross-Connection Control Specialist Number:
Please submit copies of this completed form by mail or e-mail to:
City of Santa Maria Utilities Department – Regulatory Compliance Division, 2065 East Main Street, Santa Maria, CA 93454
E-Mail: [email protected]
Attachment C
Hazard Assessment
Yes No Yes No Yes No
1 2
3 4
5 6
7 8
9 10
Detailing of Protection
Size
1 2
3 4
5 6
7 8
9 10
1 2
3 4
5 6
7 8
9 10
Does the premises contain any situations related to Appendix D of the CCCPH? If yes, the premises is considered high hazard.
Was access to the water user premises denied or restriced? If yes, the premises is considered as high hazard.
Detailing of Hazards
Make
Water Use
SerialModel
AdequateApprovedExisting Protection
No
Yes No
Yes
City of Santa Maria
Cross-Connection Control Plan
Regulatory Review - 12/30/2025
D-1
Attachment C
Hazard Assessment
Observance of cross-connections?
List the type and use of materials handled and present, or likely to be, on the user premises:
List the degree of piping system complexity and accessibility:
Does the premises have auxiliary water supplies, pumping systems, or pressure systems? Notes:
Are there any distribution system conditions that increase the likelihood of a backflow event? (e.g., hydraulic gradient differences impacted by main breaks and high water demand situations, multiple service connections that may result in flow-through conditions, etc.) Have there been any previous backflow incidents on the user premises? If yes, list date and incident specifics:
Degree of hazard Identified:
Does the premise have adequate protection?
No
No
No HazardLow Hazard
NoYes
High Hazard
Yes
Yes
Yes No
City of Santa Maria
Cross-Connection Control Plan
Regulatory Review - 12/30/2025
D-2
Attachment C
Hazard Assessment
Notes / Conclusion:
City of Santa Maria
Cross-Connection Control Plan
Regulatory Review - 12/30/2025
D-3
Attachment C
City of Santa Maria Regulatory Review – 12/30/2025
Cross-Connection Control Plan
Attachment
E
City of Santa Maria List of Air Gaps
and
Air Gap Inspection Procedure
Attachment C
List of Air Gaps
City of Santa Maria Regulatory Review – 12/30/2025
Cross-Connection Control Plan E-1
City of Santa Maria List of Air Gaps
One Air Gap
Address: 1200 W La Brea Ave Santa Maria, CA 93458
Reason: Underground Cistern Tanks used for irrigation supplement.
Notes: RP backflow assembly also located in between AG and PWS supply.
Attachment C
Air Gap Inspection Procedure
DATE DUE:
Manufacturer Type Model Size Serial # Facility # Protection AIR Air Gap
Mailing Address: Site Location:
Air Gap Installation Compliant
T Discharge Pipe Obstructed
E
S Spill Level Easily Determined
T
Measured Vertical Inches Above Overflow Rim
Supply Rim Diameter
R
E
P
A
I
R
S
COMMENTS:
INITIAL TEST DATE
Certified Tester Number Tested by: (Print)
Tested by: (Signature)
FINAL TEST DATE
Certified Tester Number Tested by: (Print)
Tested by: (Signature)
RETURN TO:
[email protected]
Acknowledged:
Owner/Occupant
Air Gap Inspection
Annual Air Gap Inspection Report
City of Santa Maria
Utilities Department - Regulatory Compliance Division
City of Santa Maria Utilites Department - Regulatory Compliance Division, 2065 East Main Street, Santa Maria, CA 93454 a building permit
must be obtained
through the City
Community
For all backflow
installations
and replacements,
If assembly replaced
state reason:
EMAIL:
If FAILED, please send the test report to the City of Santa Maria within 72 hours. of Santa Maria
Development
Department,
Building Division
at 805-925-0951
Ext. 2241.
Failed
Not Repairable
No Longer Meets
Standard
Domestic
Irrigation
Fire Service
Internal
Parts Not Available
Passed
Passed Failed
No
No
No
Yes
Yes
Yes
City of Santa Maria
Cross-Connection Control Plan
Regulatory Review - 12/30/2025
E-2
Attachment C