CITY OF SIMI VALLEY
MEMORANDUM
S
eptember 15, 2025
T
O: Board of Directors
F
ROM: Department of Public Works
S
UBJECT: A PUBLIC HEARING TO APPROVE A CROSS-CONNECTION CONTROL
PLAN AND INTRODUCTION OF AN ORDINANCE ESTABLISH ING
REQUIREMENTS FOR THE INSTALLATION, MAINTENANCE, AND
TESTING OF BACKFLOW PREVENTION ASSEMBLIES AND TO
PROHIBIT CROSS -CONNECTIONS PER NEW CROSS -CONNECTION
CONTROL POLICY HANDBOOK REGULATIONS , AND REPEALING
ORDINANCE NO. WWD-18
STAFF RECOMMENDATION
I
t is recommended that the Board of Directors:
1. A
pprove the City of Simi Valley/Ventura County Waterworks District No. 8 Cross-Connection Control Plan ( Page 10) to establish standards intended to protect public health by ensuring a public water system’s drinking water distribution system will not be subject to backflow; and
2. A
t the close of the public hearing and following the consideration of public testimony, introduce and waive first reading of the attached Ordinance No. WWD-19 (Page 6) to modify Chapter 15, Title 6 – Sanitation and Health of the Simi Valley Municipal Code (SVMC), authorize the implementation of the Cross-Connection Control Plan (“Plan”) to be consistent with new California state law requirements as outlined in the Cross-Connection Control Policy Handbook (the “Handbook”), and repeal Ordinance No. WWD-18.
BACKGROUND AND OVERVIEW
O
n May 15, 2023, the Board of Directors adopted Ordinance No. WWD -18 to set requirements for the installation, maintenance, and testing of backflow devices and prohibit cross-connections. A cross-connection is an interconnection between a potable water supply and a non- potable source either by an actual or a potential connection between a public water system and any source containing liquid, gas, or other substances not from an approved wat er supply. Backflow is contaminant or pollutant introduction through a cross-connection that occurs when the non-potable contaminant source is at a greater pressure than the potable water distribution system, which could cause illness and other public health risks.
AGENDA ITEM NO.
______5B_____
The State Water Resources Control Board (the “State Water Board” ) adopted the Handbook, effective July 1, 2024. The primary objective of the Handbook is to protect public health through the establishment of standards that ensure a drinking water distribution system for a public water system (PWS), such as the District’s, will not be subject to potentially dangerous backflow. The Handbook requires that the District develop a Plan, including a legal authority ( e.g., Ordinance) to implement the Plan, and submit to the State Water Board by July 1, 2025.
The Handbook and its standards apply to all California PWSs, as defined in California’s Health and Safety Code (CHSC, section 116275 (h)) , including the District. Compliance with this Handbook is mandatory for all California PWSs. Through the adoption of the Handbook, the State Water Board is exercising its authority, under California’s Safe Drinking Water Act, to establish enforceable standards applicable to California’s PWSs.
Failure to comply with the Handbook may result in the issuance of compliance, enforcement, or other corrective actions against a PWS.
Following the submittal of the new Plan by July 1, 2025, the new Plan must be adopted and Ordinance No. WWD-18 must be replaced to comply with new requirements set forth by the State Water Board in the Handbook.
FINDINGS AND ALTERNATIVES
Due to the additional standards specified in the Handbook , the Ventura County Environmental Health Division terminated its contract to implement the Cross-Connection Control Program with the District as of July 1, 2025. The District needs to develop and implement its own Plan. The District retained Backflow Solutions, Inc. (BSI) to assist the District with the preparation and implementation of the Plan. District Staff submitted a draft Plan (Attachment A) to the State Water Board on July 1, 2025, to comply with the deadline. The Plan includes the implementation of a
cross-connection control program under a certified specialist and a timeframe to conduct and complete a hazard assessment for all water service connections within the District’ s service area to determine the degree of hazard at each user premise and assign commensurate backflow protection. Given that Ordinance No. WWD-18 already provides the District legal authority to implement corrective actions to prevent backflow incidents ; it is recommended that Ordinance No. WWD-18 be repealed and replaced by Ordinance WWD-19 to reference the Handbook and serve as the legal authority for the Plan.
In order to meet the Plan requirements, the District must retain a certified Cross - Connection Control Specialist who will be responsible for leading the District’ s cross- connection control and backflow prevention program, conducting surveys and field inspections, coordinating device testing, completing Annual Reports and any other deliverables required by the State Water Board, and partnering with customers and contractors. The Cross-Connection Control Specialist must have a valid certificate as a "Backflow Prevention Tester" issued by the California/Nevada Section of the American Water Works Association (AWWA).
Staff contacted G&G Environmental Compliance, Inc. (G&G) and requested a proposal to provide Backflow Prevention and Cross Connection Control Program services. The proposal received from G&G indicated a fee of $350,200 annually to provide 2 administration of the Backflow Program services, and a fee of $314,850 annually for the Hazard Assessment services. As an alternative, staff recommends adding a new full-time position for a certified Cross-Connection Control Specialist. The anticipated salary range for a Cross Connection Control Specialist is typically between $90,000 and $130,000 per year. This new position will be requested at mid- year, or in the FY 2026- 27 Waterworks budget.
The following alternatives are available to the Board of Directors:
1. Approve the City of Simi Valley/Ventura County Waterworks District No. 8 Plan to establish standards intended to protect public health by ensuring a public water system’s drinking water distribution system will not be subject to backflow;
2. At the close of the public hearing and following the consideration of public testimony, introduce and waive first reading of Ordinance No. WWD -XX to modify Chapter 15, Title 6 – Sanitation and Health of the Simi Valley Municipal Code (SVMC) to authorize the implementation of the Cross -Connection Control Plan and to be consistent with new California s tate law requirements as outlined in the Cross -Connection Control Policy Handbook and repealing Ordinance No. WWD-18;
3. P rovide other direction to staff.
Staff recommends Alternative No. 1 and 2.
SUGGESTED BOARD OF DIRECTORS MOTION
I move to approve the City of Simi Valley/Ventura County Waterworks District No. 8 Cross-Connection Control Plan and introduce and waive first reading of Ordinance WWD-
19. SUMMARY
Effective July 1, 2025, the District was required to update its current Ordinance No. WWD- 18 to reference new regulations from the State Water Board. Ordinance No. WWD-18 referenced California Code of Regulations Title 17, which is now inoperable and superseded by the adoption of the Handbook . Based on requirements set forth in the Handbook, the District submitted a draft Plan to the State Water Board prior to the July 1, 2025, deadline. The final Plan must include a legal authority (ordinance) to implement corrective actions in the event a water user fails to comply in a timely manner with the District’s provisions regarding the installation, inspection, field testing, or maintenance of backflow prevention assemblies.
It is recommended at the close of the public hearing and following the consideration of public testimony and written proposals, the Board of Directors adopt the Plan, introduce for first reading Ordinance WWD-19 to modify Chapter 15, Title 6 – Sanitation and Health of the SVMC to establish requirements for the installation, maintenance, and testing of backflow prevention assemblies to prohibit cross -connections to be consistent with new California State law requirements as outlined in the Handbook, and repeal Ordinance No.
WWD-18.
3 Ronald K. Fuchiwaki
Public Works Director
Prepared by: Michel Kadah, Principal Engineer
Index Page
Public Hearing Procedure .................................................... 4 Proposed Ordinance No. WWD-19 ...................................... 6 Attachment A – Cross-Connection Control Plan ................ 10
4 PUBLIC HEARING PROCEDURE
HEARING DATE: September 15, 2025
1. CITY CLERK: This is the time and place set for a public hearing to consider approving a Cross-Connection Control Plan and introduction of an ordinance establishing requirements for the installation, maintenance, and testing of backflow prevention assemblies and to prohibit cross-connections per new Cross-Connection Control Policy Handbook regulations, and repealing
Ordinance No. WWD-18
2. MAYOR: Before we begin, are there any ex parte communications to report?
3. ANY COUNCIL
MEMBER: (Report)
4. MAYOR: Staff may begin with the oral report on this matter.
5. STAFF: (Report)
6. MAYOR: Any questions of staff from City Council Members? (Questions of staff and staff response)
7. MAYOR: At this time, I would like to open the hearing for anyone in the City Council Chambers wishing to be heard on this matter.
8. AUDIENCE: Public Testimony and Comments
9. MAYOR: Does Staff desire to respond to any comments or issues raised?
10. STAFF: (Response to comments and additional City Council questions)
11. MAYOR: The hearing is now closed.
12. MAYOR: Any further comments or questions from City Council Members?
13. MAYOR: I will now entertain a motion.
5 14. ANY COUNCIL
MEMBER : NOTE: PICK THE APPLICABLE ACTION(S) & CHANGE ITEM NUMBER(S) OF ACTION(S) AS NEEDED:
City Council Actions (by motion of any Council Member)
(Both):
1) Approve the Cross-Connection Control Plan; and
2) Introduce, modify, or not introduce Ordinance
No. WWD-19 establishing requirements for the
installation, maintenance, and testing of backflow
prevention assemblies and to prohibit cross -connections per new Cross -Connection Control Policy H andbook
regulations, and repealing Ordinance No. WWD-18 _____
(does not require a second or a vote; requires reading of ordinance).
*Any action to refer the matter back to staff or to continue the matter requires a second and a vote.
15. ANY COUNCIL
MEMBER : Second
16. MAYOR: (Call for vote)
17. MAYOR: Proceed to the next item.
6 ORDINANCE NO. WWD-19
AN ORDINANCE OF THE BOARD OF DIRECTORS OF
VENTURA COUNTY WATERWORKS DISTRICT NO. 8
ADDING CHAPTER 15 TO TITLE 6 - SANITATION AND
HEALTH OF THE MUNICIPAL CODE OF THE CITY OF SIMI
VALLEY REPLACING ORDINANCE WWD- 18 AND
ESTABLISHING REQUIREMENTS FOR THE
INSTALLATION, MAINTENANCE, AND TESTING OF
BACKFLOW PREVENTION ASSEMBLIES AND THE
PROHIBITION OF CROSS -CONNECTIONS PER CROSS -
CONNECTION CONTROL POLICY HANDBOOK
REGULATION
THE BOARD OF DIRECTORS OF VENTURA COUNTY WATERWORKS
DISTRICT NO. 8 DO ORDAIN AS FOLLOWS:
SECTION 1. Findings.
A. The District seeks to update the Simi Valley Municipal Code to conform with updated state law regarding certain utility cross -connections in accordance with its implement its Cross-Connection Control Plan.
B. This Ordinance is exempt from the California Environmental Quality Act (CEQA) pursuant to the common sense exemption set forth in Section 15061(b)(3) of the State CEQA Guidelines, which provides that CEQA applies only to projects which have the potential for causing a significant effect on the environment. It can be seen with certainty that there is no possibility that adoption of this ordinance, which establishes regulatory requirements for cross-connection control and backflow prevention to protect the City’s potable water system, may have a significant effect on the environment. In addition, this ordinance is exempt under the Class 8 Categorical Exemption in Section 15308 of the State CEQA Guidelines, which exempts actions taken by regulatory agencies for the protection of the environment. The ordinance establishes inspection, maintenance, and compliance requirements to prevent the contamination of the City’s potable water supply, which is an environm ental protection measure. T herefore, no further environmental review is required under CEQA.
SECTION 2. Amendments. Chapter 15, of Title 6, of the Simi Valley Municipal Code is amended in its entirety to read as follows:
“TITLE 6. SANITATION AND HEALTH CHAPTER 15. VENTURA
COUNTY WATERWORKS DISTRICT NO. 8 (WWD8) BACKFLOW PREVENTION ASSEMBLIES INSTALLATION, MAINTENANCE AND TESTING; AND
PROHIBITION OF CROSS-CONNECTIONS.
Article 1. – General
The Ventura County Waterworks District No. 8 (District) is a water purveyor that serves customers within the City of Simi Valley and some unincorporated areas of 7 Ventura County. Prior to A ssembly Bill 1671 and the Cross -Connection Control Policy Handbook (CCCPH), adopted December 19, 2023 and effective July 1, 2024, California’s regulations pertaining to cross -connection control were set forth in regulations in the California Code of Regulations ( CCR), Title 17. 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)). All water purveyors are required to protect the quality and safety of their potable water supplies from potential backflow from customer properties into a water purveyor’s water distribution system. Such backflow can cause contamination or pollution of the potable water supply posing a public health risk. Furthermore, water purveyors are also required to prohibit cross -connections between a customer’s potable water system and other customer systems containing non- potable water or other fluids that could potentially backflow into the water purveyor’s potable water distribution system.
Section 6-15.01 – Purpose and Intent
The District shall protect the public water supply from contamination by the implementation of a cross -connection control program. The program, or any portion thereof, may be implemented directly by the District or by means of a contract with a certified cross-connection control specialist. The District’s cross -connection control program shall be for the purpose of addressing the requirements of CCCPH.
The purpose of this chapter is to:
a) Establish a cross-connection control program and meet the mandates of public health law concerning drinking water supplies as outlined in the Federal Safe Drinking Water Act and in CCCPH;
b) Protect the District’s potable water supply from actual and potential cross - connection by isolating within the pr operty any contamination or pollution that could backflow into the water supply system via an undiscovered or unauthorized cross-connection on the property;
c) Provide for the maintenance of a continuing cross-connection control program that will systematically and effectively prevent the contamination or pollution of all potable water systems;
d) Eliminate existing unprotected connections between drinking water systems and other sources of water that are not approved as potable and safe for human consumption;
e) Eliminate cross -connections between drinking water systems and other sources of water or process water used for any purpose whatsoever that may jeopardize the safety of the potable water system;
f) Prohibit cross-connections in the future.
8 The intent is to recognize that there are varying degrees of cross-connection hazards and to apply the principle that the degree of protection should be commensurate with the degree of hazard.
Section 6-15.02 – Definitions
The following terms are defined for the purpose of this ordinance and supported by additional definitions in Section 3.1.1 of the CCCPH:
a) “Backflow” shall mean the reverse flow of water, or any other fluid or substance or any combination or any mixture thereof, from the customer’s system into the District’s potable water distribution system.
b) “Board” shall mean the Board of Directors of the Ventura County Waterworks District No. 8.
c) “Backflow Prevention Assembly” shall mean an assembly that protects the District’s potable distribution system from backflow.
d) “Certified tester” shall mean a person able to field test and make reports on backflow prevention assemblies possessing a valid certification issued by a certifying organization recognized by the California State Water Resources Control Board (State Water Board).
e) “City” shall mean the City of Simi Valley.
f) “Cross-Connection” shall mean any actual or potential connection between the District’s potable water system and any source or system containing unapproved water or a substance that is not or cannot be approved as safe, wholesome, and potable.
g) “Cross-Connection Control Specialist” shall mean a person certified as a cross- connection control specialist and possessing a valid certification from a certifying organization by the State Water Board.
h) “Customer or responsible party” shall mean any person that either has applied for water service from the District, or owns or controls water piping or fixtures served by the District’s water supply. The terms customer and responsible party have the same meaning.
i) “Director” shall mean the City of Simi Valley’s Public Works’ Director.
j) “District” shall mean the Ventura County Waterworks District No. 8, or its authorized representative.
k) “District Engineer” shall mean the Assistant Public Works Director of Utilities Engineering of the Ventura County Waterworks District No. 8. 9 l) “District Manager” shall mean the Ventura County Waterworks District No. 8 Manager.
m) “Service Area” shall mean areas in which the Ventura County Waterworks District No. 8 provides potable water service within the City of Simi Valley and some unincorporated areas of Ventura County.
n) “Service Connection” shall mean the point of connection of a customer’s system to the District’s water system.
o) “Water system” shall mean the Ventura County Waterworks District No. 8 potable water system.
Section 6-15.03 – General Requirements
a) Backflow prevention assemblies shall be required per Section 6-15.04.
b) Backflow prevention assemblies must be approved by the University of Southern California’s Foundation for Cross -Connection Control and Hydraulic Research.
c) B ackflow prevention assemblies are owned and maintained by the customer.
d) C ustomer shall have required backflow prevention assemblies installed in accordance with the District’s Water Design and Construction Standards , Section 6-15.07 of this Ordinance, and the California Uniform Plumbing Code.
e) C ustomer shall be responsible for inspections, repairs, and proper testing of all backflow prevention assemblies installed on their property in accordance with Section 6-15-.08 of this Ordinance.
f) Customer shall permit the District , the cross- connection control specialist , and/or a certified tester, to enter customer’s property within the normal working hours of the District, or in case of emergency, at any time, to test or inspect the backflow prevention assembly.
g) Customer shall be responsible for obtaining the required permits to install or replace a backflow prevention assembly.
h) Backflow prevention assemblies shall be installed on private property, as close as practical to the meter, but no further than ten (10) feet from the public-right- of way or District’s easement.
i) A property with multiple domestic service connections to the water system shall have a backflow prevention assembly installed on each service connection, if 10 required. All service connections shall be protected to the highest degree found during the hazard assessment.
Section 6-15.04 – Hazard Assessments
The District has jurisdiction and maintains the water system up to and including the water meter that provides service to a property. All piping beyond the water meter , including backflow prevention assemblies, shall be the responsibility of the customer.
a) Per Section 3.2.1 of the CCCPH, an initial hazard assessment to evaluate the potential for backflow into a public water system must be conducted. The assessment will include an inspection of the customer’s property within its system service area.
The hazard assessment must consider:
1) The existence of cross-connections;
2) The type and use of materials handled and present, or likely to be, on the customer’s property;
3) T he degree of piping system complexity and accessibility; 4) A ccess to auxiliary water supplies, pumping systems, or pressure systems; 5) 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.);
6) Customer’s property accessibility;
7) A ny previous backflow incidents on the customer’s property; and 8) T he requirements and information provided in the CCCPH.
Within five (5) business days from receiving notification, the water service customer shall grant designated / contract water staff access to the property and buildings. Failure to provide access may result in water termination.
b) Each hazard assessment must identify the degree of hazard to the public water systems distribution system as either a high hazard cross -connection, a low hazard cross connection, or having no hazard. Examples of some high hazard cross-connection activities may be found in Appendix D of the CCCPH.
c) The hazard assessment must determine whether an existing BPA, if any, provides adequate protection based on the degree of hazard.
d) Hazard assessments completed prior to the adoption of the CCCPH may be considered as an initial hazard assessment , provided that such hazard assessments and associated backflow protection provide protection consistent with the CCCPH and the public water systems describe their review of these assessments in the Cross-Connection Control Plan required in CCCPH Section
3.1.4. 11
e) Subsequent to the initial hazard assessment described in subsection (a), a community water system must perform a hazard assessment under the following criteria:
1) I f a customer’s property changes account holder, excluding single -family residences;
2) I f a customer’s property is new or re-connected to the public water systems; 3) I f evidence exists of changes in the activities or materials on a customer’s property;
4) I f a backflow incident occurs from a customer’s property; 5) P eriodically, as identified in the public water systems Cross-Connection Control Plan required pursuant to CCCPH section 3.1.4.; 6) I f the State Water Board requests a hazard assessment of a customer’s property;
7) I f the public water systems conclude an existing hazard assessment may no longer accurately represent the degree of hazard.
f) A cross-connection control specialist must review or conduct each initial and follow up hazard assessment pursuant to this section and make a written finding that, in the specialist’s judgment based on cross -connection control principles, the public water systems hazard assessment properly identified all hazards at the time of the assessment, the appropriate degree of hazards, and the corresponding backflow protection.
Section 6-15.05 – Temporary Water Service Connections
The District may require appropriate b ackflow prevention assemblies to be installed and tested for all temporary water service connections to eliminate the potential for any backflow.
Section 6-15.06 – Booster Pumps
For properties having private booster pumps to address low water pressure or special operations, the booster pump shall be equipped with a low-pressure cutoff switch designed to shut off the pump when the water pressure on the inlet side is 25 pounds - per-square-inch or lower.
Private booster pump installations within the City of Simi Valley shall be subject to approval by the Environmental Services Department, Building and Safety Division.
Private booster pump installations outside of the City of Simi Valley boundary, but within the District’s service area shall be subject to approval by the Ventura County Building and Safety Division.
Section 6-15.07 – Installation
a) Backflow prevention assemblies shall be installed in accordance with the CCCPH, the Waterworks District No. 8 Water and Design Construction Standards (WDCS), 12 the California Uniform Plumbing Code, and the most recent edition of the USC Foundation for Cross-Connection Control and Hydraulic Research.
b) W hen a new water service is requested for a proposed development , the District will review the application to determine the required type of backflow prevention assembly. It shall be the customer’s responsibility and expense to have the required backflow prevention assembly installed. No connections shall be permitted between the water meter and the backflow prevention assembly.
c) A n existing backflow prevention assembly that does not provide adequate protection for the degree of potential hazard from backflow must be replaced at the customer’s expense.
d) No modifications to, or removals of approved backflow prevention assemblies shall be permitted unless approved by the District in writing.
e) All newly installed and approved backflow prevention assemblies must be tested and certified as functioning properly prior to the water service being turned on.
Section 6-15.08 –Testing
a) Approved backflow prevention assemblies shall be tested by a certified tester using test procedures outlined in the most recent edition of the Manual of Cross - Connection Control published by the USC Foundation for Cross -Connection Control and Hydraulic Research.
b) Backflow prevention assemblies shall be tested at least annually, or more frequently if determined necessary by the cross-connection control specialist. The District shall notify customers when annual testing is required, and the notice shall contain the date when the test must be completed, and test results submitted.
c) Backflow prevention assemblies that fail to pass testing shall be repaired and retested immediately, at the expense of the customer. The backflow prevention assembly must not be placed in service unless the assembly is functioning as required.
d) For backflow prevention assemblies that fail to pass inspection and testing, the District reserves the right to require more frequent testing or to perform additional testing by a certified tester when the District determines it to be in the public interest. Customer shall bear the cost of additional tests.
e) If customers do not test their backflow prevention assembly and their assembly is out of compliance with the annual test requirement, the District reserves the right to have the assembly tested by a certified tester and charge the customer accordingly. Charges shall consist of a penalty fee, an inspection fee, testing fee, and any associated costs of repairing/replacing the backflow prevention assembly.
13 f) The certified tester must complete and upload the assembly test report to the public water service backflow portal demonstrating testing and inspection compliance within 30 days of the annual notice. If the certified tester does not submit the test results within 30 days, the District shall assess a penalty fee and send a second notice to the customer. The second notice shall notify the customer that water service to the property will be terminated if test results are not submitted by the date specified on the second notice.
g) The customer shall at all times maintain the backflow prevention assembly in proper working order and provide unobstructed access to the District, cross - connection control specialist, and certified tester.
Section 6-15.09– Prohibition of Cross-Connections
a) Where a property has alternative water sources or operate processes that utilize non-potable water or other fluids, cross -connections from these sources or facilities are prohibited. For properties within the City bound ary, the City of Simi Valley’s Building and Safety Division shall inspect and approve all on-site plumbing downstream of the District -required backflow prevention assemblies and ensure that there are no such cross -connections. For properties outside of the City boundary but within the District’s service area, the Ventura County Building and Safety Division shall conduct the inspection.
b) The customer shall secure a Building Permit from their respective Building and Safety Divisions to ensure the required inspection and approval prior to modifying on-site plumbing that may result in a cross-connection.
c) The cross-connection control specialist shall have access to inspect on- site facilities to check for cross -connections and to determine if the potable water system is protected from backflow.
Section 6-15.10– Penalties
a) For each water customer that fails to have a satisfactory hazard assessment performed, for each water customer that fails to have the appropriate required backflow prevention assembly installed or replaced, and for each backflow prevention assembly that is out of compliance with the annual test requirement, the District shall, as necessary, apply any of the following enforcement measures:
1) Deny or discontinue water service to a water user
2) Use of penalty fine(s) on water users, per the current fees in the City of Simi Valley’s Summary of Service of Charges
3) Install, inspect, field test, and/or maintain a BPA at a water user’s premises and charge the customer a penalty fee equivalent to the full cost recovery of all materials and staff time per the current fees in the City of Simi Valley’s Summary of Service of Charges.”
14 SECTION 3: Construction. This Ordinance must be broadly construed to achieve the purposes stated in this Ordinance. It is the City Council’s intent that the provisions of this Ordinance be interpreted or implemented by the City and others in a manner that facilitates the purposes set forth in this Ordinance.
SECTION 4: Renumbering. All provisions of the Simi Valley Municipal Code this Ordinance affects are appropriately renumbered.
SECTION 5: Summaries of Information. All summaries of information in the findings herein are based on the substantial evidence in the record. The absence of any particular fact from any such summary is not an indication that a particular finding is not based in part on that fact.
SECTION 6: Severability. If any part of this Ordinance or its application is deemed invalid by a court of competent jurisdiction, the City Council intends that such invalidity will not affect the effectiveness of the remaining provisions or applications and, to this end, this Ordinance’s provisions are severable.
SECTION 7: Recordation. The City Clerk, or designee, is directed to certify the passage and adoption of this Ordinance; cause it to be entered into the City of Simi Valley’s book of original ordinances; make a note of the passage and adoption of this Ordinance; and cause it to be published or posted in accordance with California law.
SECTION 8: Effective Date. This ordinance shall go into effect and be in full force and effect at 12:01 a.m. on the thirty -first (31st) day after its passage, and the fees and charges shall apply on the effective date.
PASSED and ADOPTED this ____ day of _________ 2025.
ATTEST:
Lucy Blanco, District Secretary Dee Dee Cavanaugh, Chair of the Ventura County Waterworks District
No. 8
Approved as to Form: Approved as to Content:
Algeria R. Ford, District Attorney Samantha C. Argabrite, District Manager
_________________________________
Ronald K. Fuchiwaki
Public Works Director
15 Cross-Connection Control Plan
Effective Date: July 1, 2025
ATTACHMENT A
16 Table of Contents
Section 1.0 – Introduction and Program Requirements ................................................................................. 1
1.1 – Background ............................................................................................................................................. 1
1.2 - Public Community Water System (PWS) Information ....................................................................... 1
1.3 - Water System Ownership Type ............................................................................................................ 1
1.4 - PWS Background CCC Information..................................................................................................... 2
1.5 - Requirement for Program ...................................................................................................................... 2
1.6 – Objectives ............................................................................................................................................... 2
1.7 - Definitions ................................................................................................................................................ 3
1.8 - Attachments to this Plan ........................................................................................................................ 3 Section 2.0 - Operating Rules or Ordinances (Legal Authority) ................................................................... 4 Section 3.0 - Cross-Connection Control Program Coordinator .................................................................... 5 Section 4.0 - Hazard Assessments ................................................................................................................... 8
4.1 - Initial Cross-Connection Hazard Assessments .................................................................................. 8
4.2 - Cross-Connection Hazard Survey Schedule for Initial Hazard Assessments ............................... 8
4.3 - Fire Protection Systems ........................................................................................................................ 9
4.4 - Water User Supervisors ........................................................................................................................ 9
4.5 - Cross-Connection Hazard Survey Schedule for Hazard Reassessments..................................... 9
4.6 - Enforcement .......................................................................................................................................... 10 Section 5.0 – Backflow Prevention ................................................................................................................. 11
5.1 - Backflow Preventer Requirements..................................................................................................... 11
5.2 - Approved BPA and Installation ........................................................................................................... 11
5.3 - Schedule for Installation of BPA ......................................................................................................... 12
5.4 - Air Gaps ................................................................................................................................................. 12
5.5 - Enforcement .......................................................................................................................................... 12 Section 6.0 Certified BPA Testers and Certified CCC Specialists ............................................................. 13
6.1 - Pre-Approval Qualifications ................................................................................................................ 13 Section 7.0 - BPA Testing ................................................................................................................................. 14
7.1 - Inspection and Testing of BPA ........................................................................................................... 14
7.2 - Frequency of Inspection and Testing ................................................................................................ 14
7.3 - Responsibility for Inspection and Testing ......................................................................................... 14
7.4 - Approved Test Procedures ................................................................................................................. 14
7.5 - Notification of Routine (i.e. Annual) BPA Testing ............................................................................ 14
7.6 - Notification of Non-Routine BPA Testing .......................................................................................... 15 17 7.7 - Enforcement .......................................................................................................................................... 15 Section 8.0 - Recordkeeping ............................................................................................................................ 16
8.1 - Types of Records and Data to be Maintained .................................................................................. 16
8.2 - Methods of how data is maintained and/or stored ........................................................................... 16 Section 9 - Backflow Incident Response, Reporting, and Notification ...................................................... 17
9.1 - Backflow Incident Response Plan ...................................................................................................... 17
9.2 - Backflow Incident Notification ............................................................................................................. 17 Section 10.0 - Public Outreach and Education ............................................................................................. 18 Section 11.0 - Local Entity Coordination ......................................................................................................... 19 Section 12.0 - Cross-Connection Control Plan Certification ....................................................................... 20
ATTACHMENTS
Attachment A – Draft Copy of Legal Authority, Ordinance No. (TBD) Attachment B - ASME A112.1.2 -2012 (R2017) Table 1, Minimum Air Gaps for Generally used Plumbing Fixtures
Attachment C – Ventura County Waterworks District No. 8 Incident Report Attachment D – Residential Sprinkler BPA Exemption
18 1
Cross-Connection Control Plan
Section 1.0 – Introduction and Program Requirements
1.1 – Background
The City of Simi Valley/Ventura County Waterworks District No. 8 (District) delivers high- quality drinking water to approximately 26,000 residential, industrial, and commercial customers within the City of Simi Valley and some unincorporated areas in Ventura County. To protect Simi Valley’s drinking water from potential contamination, the City of Simi Valley, Ventura County Waterworks District No. 8 adopted Ordinance No. WWD -18 on May 15, 2023, to set requirements for the installation, maintenance, and testing of backflow devices and to prohibit cross -connections. These regulations follow standards set by Title 17 of the California Code of Regulations that require water purveyors to protect the quality and safety of their potable water supplies from potential backflow from customer properties into a water purveyor’s water distribution system. A cross -connection is an unprotected, actual or potential connection between the District’s potable water system and any source or system containing unapproved water or a substance that is not or cannot be approved as safe, wholesome, and potable. Backflow is a reverse flow of water, or any other fluid or substance or any combination or any mixture thereof, from the customer’s system into the District’s potable water distribution system.
The State Water Resources Control Board (SWRCB) adopted the Cross-Connection Control Policy
Handbook (CCCPH) effective July 1, 2024 , which supersedes Title 17. The primary objective of CCCPH is the protection of public health through the establishment of standards intended to ensure a public water system’s (PWS) drinking water distribution system will not be subject to the backflow of liquids, gases, or other substances. The CCCPH and its standards apply to all California PWSs, as defined in California’s Health and Safety Code (CHSC, section 116275 (h)). Compliance with this CCCPH is mandatory for all California PWSs. Through the adoption of the CCCPH, the State Water Board is exercising its authority, under California’s Safe Drinking Water Act (SDWA), to establish enforceable standards applicable to California’s PWSs. The Cross-Connection Control Plan (CCCP) presented in this document complies with the requirements set forth in the CCCPH.
1.2 - Public Community Water System (PWS) Information
Public Water System Name Ventura County Waterworks
District No. 8 - Simi Valley
Public Water System Number CA5610023
Number of Single-Family Residential Service Connections 23,664 Number of Multifamily Residential Service Connections 461 Number of Commercial Connections 800
Number of Industrial Service Connections 77
Number of Agricultural Service Connections 37
Number of Landscape Irrigation Connections 791
Total Number of Service Connections 25,830
1.3 - Water System Ownership Type
The District is a public water purveyor that serves customers within the City of Simi Valley and some un-incorporated areas of Ventura County. The District supplies water to approximately 68% of Simi Valley residences, businesses, and institutions . Golden State Water Company, private company, 19 2
supplies the remainder.
1.4 - PWS Background CCC Information
Description Number Actions
Number of Fire Protection System Service Connections
(Residential)
67 District will verify if fire
protection system alternative
is needed
Number of Fire Protection System Service Connections
(Non-Residential)
361 District will verify if fire
protection system alternative
is needed
Number of Air Gaps used for backflow protection at the
service connection
0 N/A
Number of Service Connections where internal
protection is used in lieu of premises containment
0 N/A
Number of Recycled Water (RW) use sites 3 District will verify if any RW use sites use swivel-els or air
gaps
Number of Swivel-ells used for backflow protection at the service connection (applies to Recycled Water use sites) 0 N/A
1.5 - Requirement for Program
VENTURA COUNTY WATERWORKS DISTRICT NO. 8 – SIMI VALLEY , PWS IDENTIFICATION #CA5610023 hereinafter referred to as “ District”, has the responsibility to protect the public water supply through implementation and enforcement of a cross -connection control (CCC) program.
District has contracted with BSI Online, to manage and provide technical assistance and consulting services. BSI Online has on staff a certified CCC Specialist to oversee the development of the CCC program. Any reference to the District may include contracted staff, e.g., BSI Online.
The CCC requirements are contained in the Cross -Connection Control Policy Handbook (CCCPH), which is incorporated into the State of California’s Drinking Water Regulations and became effective July 1, 2024. The CCCPH requires the District CCC program to include certain minimum elements.
Per the CCCPH, the minimum required elements of a CCC program are:
Element 1: Operating rules or ordinances
Element 2: Cross-connection control program coordinator Element 3: Hazard assessments
Element 4: Backflow prevention
Element 5: Certified backflow prevention assembly testers and certified cross-connection control specialists
Element 6: Backflow prevention assembly testing
Element 7: Recordkeeping
Element 8: Backflow incident response, reporting and notification Element 9: Public outreach and education
Element 10: Local entity coordination
1.6 – Objectives
a) This Policy implements the SWRCB ’s CCCPH to protect public water systems through backflow prevention and cross-connection control.
b) To protect customers from contamination or pollution from any on-site hazards; and 20 3
c) To promote the elimination or control of existing cross -connections actual or potential, between its customers' potable water system(s) and nonpotable water systems, plumbing fixtures and industrial piping systems; and
d) To provide for the maintenance of a continuing cross -connection control program which will systematically and effectively prevent the contamination or pollution of the District potable water system.
1.7 - Definitions
For purposes of this Section, the definitions in the latest version of the State Water Resources Control Boards CCCPH shall apply.
1.8 - Attachments to this Plan
Attachment A – Draft Copy of Legal Authority, Ordinance No. (TBD) Attachment B – ASME A112.1.2-2012 (R2017) Table 1, Minimum Air Gaps for Generally used Plumbing Fixtures
Attachment C – Ventura County Waterworks District No. 8 Incident Report Attachment D – Residential Sprinkler BPA Exemption
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Section 2.0 - Operating Rules or Ordinances (Legal Authority)
Per the CCCPH, each PWS must have operating rules, ordinances, by-laws, resolution, or service contract or agreement to implement the CCC program.
The District will adopt Ordinance Number (TBD), which authorizes the implementation of a CCC program (See Attachment A).
The legal authority also authorizes the District to perform the following corrective action in the event a water user fails to comply with the CCC Program in a timely manner:
a) Deny or discontinue water service to a water user
b) Use of penalty fine(s) on water users, per the current fees in the City of Simi Valley’s Summary of Service of Charges
c) Install, inspect, field test, and/or maintain a backflow prevention assembly at a water user’s premises and charge the customer a penalty fee equivalent to the full cost recovery of all materials and staff time per the current fees in the City of Simi Valley’s Summary of Service of Charges
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Section 3.0 - Cross-Connection Control Program Coordinator
Per the CCCPH, the PWS must designate at least one individual involved in the development of and be responsible for the reporting, tracking, and other administration duties of its CCC program.
For PWS with 1,000 or more service connections, the CCC program must be developed in consultation with a CCC specialist.
For PWS with more than 3,000 service connections the CCCC program coordinator must be a CCC specialist. The CCC specialist must be a permanent or contracted employee of the PWS. The CCC specialist, or the CCC specialist designee, must be able to be contacted within one hour.
To meet the certified CCC specialist requirement, the District will retain a certified CCC Specialist on staff and/or contract to provide the necessary CCC expertise and services. The following cross- connection related tasks to be performed by or under the direction of the certified CCC specialist:
a) Preparation of and recommendations regarding changes to the CCC program b) Performance of and/or review and approval of CCC hazard assessments c) Provide recommendations on the type of Backflow Prevention Assembly (BPA) to be installed d) Provide recommendations on schedules for retrofitting BPA e) Conduct or assist with the enforcement of CCC non-compliance f) Conduct inspections of BPA for proper application and installation g) Conduct review of BPA inspection and test reports (may also be performed by a certified BPA tester)
h) Provide recommendations and/or the granting of exceptions to mandatory premises containment (protection at the service connection)
i) Conduct or assist District staff in the investigation of backflow incidents and other water quality problems
j) Completion of Backflow Incident Reports
k) Completion or review and approval of CCC Annual Reports and any other deliverables required by the State Water Board
The District may delegate other CCC program activities to other personnel who are not certified CCC specialists. These personnel must be noted on the following page. These activities may include:
a) Mailing, collecting, and initial screening of hazard assessments b) Mailing of BPA testing and non-compliance notices
c) Receiving and screening of assembly testing reports
d) CCC program database administration and recordkeeping e) Distribution of public education and outreach material f) Assisting tasks associated with coordination with the local entities The following table identifies the current certified specialist employed or retained on contract by the District to manage the CCC program and/or act as the CCC technical resource.
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Name of Designated Certified CCC
Specialist
Marcos Ferreccio
Company Ventura County Waterworks District No. 8
Address 2929 Tapo Canyon Road, Simi Valley, CA 93063
Email [email protected]
Phone Number (805) 583-6804
Specialist Certification Number and
Certifying Organization
TBD
Name of CCC Coordinator Lauren Gallardo
Company Ventura County Waterworks District No. 8
Email [email protected]
Phone Number 805-583-6794
Name of CCC Coordinator Rob Herr
Company Ventura County Waterworks District No. 8
Email [email protected]
Phone Number 805-583-6871
Name of 24-hour CCC Contact Oscar Guzman
Company Ventura County Waterworks District No. 8
Title (if not the CCC Specialist) Field Services Supervisor Email [email protected]
24-hour Phone Number 805-583-6478
Any other District personnel (staff or contracted) involved with implementing the CCC Program:
Name Michel Kadah
Company Ventura County Waterworks District No. 8
CCC Role/Title Principal Engineer
Email [email protected]
Phone Number 805- 583-6893
Name Raul Escobar
Company Ventura County Waterworks District No. 8
CCC Role/Title Deputy Public Works Director (Waterworks Services)
Email [email protected]
Phone Number 805-583-6468
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Name Jody Hill
Company BSI Online (District’ Contractor)
CCC Role/Title Director Field Operations
CCC Specialist Certification ABPA, #S03-657, expires 02.26.2028 Email [email protected]
Phone Number 601-940-8845
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Section 4.0 - Hazard Assessments
The PWS must survey its service area and conduct hazard assessments per CCCPH Chapter 3, Article 2 that identifies actual or potential cross -connection hazards, degree of hazard, and any backflow protection needed.
4.1 - Initial Cross-Connection Hazard Assessments
In accordance with CCCPH Section 3.2.1, an initial hazard assessment of the user premises within the District service area must be conducted. The hazard assessment must consider the following criteria:
a) The existence of cross-connections, including:
i. The degree of hazard to the distribution system (high, low, or no hazard). ii. Whether or not the backflow assembly provides adequate protection based on the degree of hazard.
b) The type and use of materials handled and present, or likely to be, on the user’s premises
c) The degree of piping system complexity and accessibility d) Access to auxiliary water supplies, pumping systems, or pressure systems e) Distribution system conditions that increase the likelihood of backflow f) User premises accessibility
g) Any previous backflow incidents on the user premises h) The requirements and information provided in the CCCPH The procedures for conducting the hazard assessments are as follows:
a) An Initial Hazard Assessment Notification will be mailed for each connection b) Will require the water user to contract with a CCC Specialist (at the customer’s expense) to perform the initial hazard assessment
c) Will require the CCC Specialist to make a written finding that in the specialist’s judgement, the hazard assessment properly identifies all hazards at the time of the assessment, the appropriate degree of hazards, and the corresponding backflow protection required
d) Will require the CCC Specialist to submit to the District, within 60 days of notification, the results of the hazard assessment
e) The District designated CCC Specialist shall review the submitted hazard assessment for final approval
For new temporary service connections (i.e., temporary fire hydrant connections used for construction projects, emergency services connections), the District will review temporary connection applications for hazard identification. If necessary, the District staff will conduct onsite assessment or site survey for hazard identification
4.2 - 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).
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Initial Assessment Task Estimated number
to be completed
per year
Estimated
Completion Date
Hazard assessment of new connections prior to
initiating water service Ongoing
Hazard assessment of high-hazard non-residential
service connections which are listed on Appendix D of
the CCCPH
8 July 1, 2035
Hazard assessment of non-high hazard non-residential
service connections 82 July 1, 2035
Hazard assessment of residential service
connections with special plumbing facilities or
auxiliary water use
80 July 1, 2035
Hazard assessment of all other residential service
connections 2,413 July 1, 2035
Fire Protection (Sprinkler) Connections BPA
assessment and installation 43 July 1, 2034
(see Section 4.3)
4.3 - Fire Protection Systems
Per the CCCPH, the District will ensure its distribution system is protected with no less than DC protection for a user premises with a fire protection system within 10 years of the effective date of the CCCPH.
For existing fire protection systems where Double Check Valve Assembly ( DC) or Reduced Pressure Zone Assembly (RP) protection cannot be installed, the District may propose an alternative completion date or alternative method of backflow protection that provides at the least the same level of protection to the public water supply (CCCPH Section 3.2.2(e)).
Residential sprinkler systems (See Attachment D) can be exempted from DC installation if:
a) The fire system is considered to be low hazard
b) Single metered service connection to the District, which splits on premises for fire system and domestic water use
c) Piping material is NSF/ANSI Standard 61
d) Piping is looped and connected to a routinely -used fixture to prevent stagnation
4.4 - Water User Supervisors
The District may require individual water users to designate a water user supervisor for premises with complex piping configurations (i.e. industrial water lines, wastewater treatment, recycled water lines, multiple service connections). The water user supervisor would be responsible for the avoidance of cross-connections on the site.
4.5 - Cross-Connection Hazard Survey Schedule for Hazard Reassessments In accordance with CCCPH Section 3.2.1(e), the District is required to perform a hazard reassessment if one of the following criteria applies:
a) If a user premises changes account holder (excluding single family residences) b) If a user premises is newly or re-connected to the District c) If evidence exists of changes in the activities or materials on a user’s premises 27 10
d) If backflow from a user’s premises occurs
e) Periodically, as identified in this Plan
f) If the State Water Board requests a hazard assessment of a user’s premises g) If the District concludes an existing hazard assessment may no longer accurately represent the degree of hazard.
For subsequent cross-connection hazard reassessments of ALL service connections, procedures for evaluating the backflow protection requirements are:
a) District staff will review records on file and/or building permit applications for hazard re- assessment
b) District staff will conduct onsite reassessment or site survey for any new hazards, as necessary
c) District staff will conduct the reassessment periodically, as necessary d) Require the water user to submit to the District, within 60 days of notification, a hazard reassessment (at the customer’s expense) by a certified specialist
4.6 - Enforcement
When the water user (customer) fails to cause the required hazard assessment to be performed by the due date specified in the Initial Hazard Assessment Notification, the District will take the following enforcement action:
1) The District will send a second notice by US Mail giving the customer an additional 30 days to comply. The notice will also inform the customer that failure to satisfactorily respond to this notice will result in penalties in accordance with its legal authority (CCC Program Element 1).
2) If the customer does not comply with the due date given in the second notice, the customer will be subject to appropriate enforcement action as outlined in the Penalties Section of the Ordinance (Element 1).
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Section 5.0 – Backflow Prevention
The PWS must ensure that actual and potential cross -connections are eliminated when possible or controlled by the installation of approved BPA or air gaps consistent with the requirements of the CCCPH Article 3.
5.1 - Backflow Preventer Requirements
The following applies to all District water users:
a) The District will require that water service to water users with identified hazards be protected at the service connection in a manner acceptable to the District. The level of protection should be commensurate with the degree of hazard identified in the Hazard Assessment procedures (CCC Program Element 3).
b) Premises identified as high- risk for contamination will require Air Gap (AG) or RP backflow protection, unless a State Water Board- approved alternative is implemented.
A Pressure Vacuum Breaker (PVB) may be consider at high-risk irrigation services that will not have backpressure.
c) Premises identified as low-risk for pollution will require DC backflow protection. d) In lieu of premises containment, with the concurrence of the District CCC Specialist, the water user may install in- premises protection that commensurate with the degree of hazard at the user’s premises.
e) Alternative devices may be used where appropriate, such as substituting Double- Check Detector Assemblies (DCDA) or Reduced Pressure Detector Assemblies (RPDA) if suitable.
f) The District will require temporary meters (i.e., meters used for temporary service connections at fire hydrants for construction projects) with adequate backflow prevention as determined and necessary.
5.2 - Approved BPA and Installation
The District is required to ensure that BPA are approved and installed in accordance with standards noted in CCCPH Section 3.3.1 and 3.3.2.
All BPA must be installed in:
a) The orientation for which they are approved;
b) A manner and location that facilitates their proper operation, maintenance, and testing or inspection;
c) A manner that will protect them from weather -related conditions such as flooding and freezing
The District shall confirm that all newly installed or replaced PVB, Spill-Resistant Vacuum Breaker (SVB), DC, and RP devices for the protection of the water system meet approval standards based on laboratory and field evaluation tests. These tests must comply with one or more of the following standards:
a) Chapter 10 of the Manual of Cross -Connection Control, Tenth Edition, published by the University of Southern California Foundation for Cross -Connection Control and Hydraulic Research; or
b) Certification requirements for BPAs as defined in the Standards of ASSE International, current as of 2022, including ASSE 1015- 2021 for DC, ASSE 1048- 2021 for DCDA & 29 12
DCDA-II, ASSE 1013 -2021 for RP, and ASSE 1047- 2021 for RPDA & RPDA -II, all marked with the 1YT certification.
The District shall prohibit any modifications to BPAs once approved. BPA testers must inform the District promptly if a water user or District -owned BPA has been altered in any way from the approved configuration.
5.3 - Schedule for Installation of BPA
The following table shows the schedule that the District will follow for installation of BPA when required based on the hazard assessment.
The District may consider granting an extension of time 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 domestic connections with high hazards
identified
Within 60 days after water user
notification
Existing domestic connections with low hazards
identified
Within 60 days after water user
notification
Existing fire protection systems Within 60 days after water user notification
5.4 - Air Gaps
Air gaps must be installed in accordance with ASME A112.1.2- 2012(R2017) Table 1, Minimum Air Gaps for Generally used Plumbing Fixtures (See Appendix B) such that:
a) The receiving water container must be located on the water user’s premises at the service connection unless an alternate location has been approved by the District b) All piping between the water user’s service connection and the discharge location of the receiving water container must above finished grade and be accessible for visual inspection unless an alternative piping configuration is approved by the District c) The District must ensure that the air gap meets requirements listed in CCCPH Appendix B
d) Any new air gap installation at a water user’s service connection must be reviewed and approved by the District prior to installation
5.5 - Enforcement
When the water user (customer) fails to install the required backflow protection by the due date specified, the District will take the following enforcement action:
a) The District will send a second notice by US Mail giving the customer an additional 30 days to comply. The notice will also inform the customer that failure to satisfactorily respond to this notice will result in penalties in accordance with its legal authority (CCC Program Element 1)
b) If the customer does not comply with the due date given in the second notice, the customer will be subject to appropriate enforcement action as outlined in the Penalties Section of the Ordinance (Element 1)
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Section 6.0 Certified BPA Testers and Certified CCC Specialists
The PWS must ensure all BPA testers and CCC specialists used are certified per CCCPH Article 4.
The District will maintain a list of certified BPA testers and CCC Specialists that have been pre- approved by the District . The District will comply with certification requirements using the following procedures:
6.1 - Pre-Approval Qualifications
Certified BPA testers and CCC Specialists who wish to be included on the pre- approved list and/or provide testing in the District service area must apply and furnish the following information:
a) Evidence of current certification in good standing
b) Make and model of field testing equipment (BPA testers only) c) Evidence of test equipment verification of accuracy and/or calibration within the past 12 months (BPA testers only)
This list will be reviewed and revised periodically, as necessary.
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Section 7.0 - BPA Testing
The PWS must develop and implement a procedure for ensuring all BPA are field tested, inspected, and maintained and air gaps are inspected and maintained in accordance with CCCPH Section 3.3.3.
7.1 - Inspection and Testing of BPA
All BPA used for the District CCC Program will be subject to inspection and, if applicable, testing by the District. This includes BPA installed for internal protection within a user’s premises in lieu of premises containment. The District must have access to the user premises and must ensure that the on- site protection meets the requirements of the CCCPH for installation, field testing, and inspections.
Inspection and testing of BPA will be as follows:
a) A certified CCC specialist will inspect BPA for proper application (i.e., to ensure that the BPA installed is commensurate with the degree of hazard) b) Either a certified CCC specialist or certified BPA tester will perform inspections of BPA for correct installation
c) A certified BPA tester will test assemblies
7.2 - Frequency of Inspection and Testing
Inspection and testing of BPA will be conducted:
a) At the time of installation;
b) Annually (approximately 12 months) or more frequently after installation; c) After a backflow incident; and
d) After BPA repair, reinstallation, relocation, or re-plumbing The District, State Water Board, or local health agency may require a BPA to be inspected and/or tested more frequently than once a year.
7.3 - Responsibility for Inspection and Testing
To ensure that all BPA are inspected and tested, the District will require the customer to be responsible for inspection, maintenance, and testing of BPA that are owned by the customer.
7.4 - Approved Test Procedures
The District will require that all assemblies relied upon to protect the public water system be tested in accordance with test procedures as described in the most recent edition of the USC Foundation for Cross-Connection Control and Hydraulic Research Manual Any proposal to use alternate test procedures must be approved by the District certified CCC Specialist.
7.5 - Notification of Routine (i.e. Annual) BPA Testing The District will notify customers via USPS Mail who own BPA used for public water system protection to have their BPA inspected and/or tested each year. Notices will be sent out not less than 30 days before the due date of the inspection and/or test. The notice will also specify the date (up to 30 days after the due date of the inspection and/or test date) by which the test report must be received by the District.
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7.6 - Notification of Non-Routine BPA Testing
In situations when non- routine BPA inspection and/or testing is needed, the District will notify customers via USPS Mail to have their BPA inspected and/or tested. The notice will also specify the date (up to 30 days after the due date of the inspection and/or test date) by which the test report must be received by the District.
7.7 - Enforcement
When the District has not received a test report by the due date specified, the District will take the following enforcement action:
a) The District will send a second notice by US Mail giving the customer an additional 30 days to comply. The notice will also inform the customer that failure to satisfactorily respond to this notice will result in penalties in accordance with its legal authority (CCC Program Element 1).
b) If the customer does not comply with the due date given in the second notice, the customer will be subject to appropriate enforcement action as outlined in the Penalties Section of the Ordinance (Element 1).
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Section 8.0 – Recordkeeping
The PWS must develop and implement a recordkeeping system in accordance with the CCCPH Section 3.5.1.
8.1 - Types of Records and Data to be Maintained
The District will maintain the following records, which will be made available to the State Water Board upon request:
a) Two most recent hazard assessments for each customer’s premises; b) Information on each BPA used for public water supply protection, including the associated hazard or application, location, owner, type, manufacturer and model, size, installation date (if known), and serial number
c) Information on air gaps used for public water supply protection, including installation, associated hazard or application, location, owner, and as-built plans of the air gap d) Results of all BPA field testing, air gap inspections, swivel-ell inspections and field tests for the previous three calendar years, including the BPA tester name and certification number, BPA test date, BPA repair date
e) Information on repairs made to, or replacement or relocation of, BPA for the previous three calendar years
f) Information on the most current cross-connection tests performed g) Information on user supervisors if required for customers’ premises, including current contact information, any applicable training and qualifications h) Descriptions and follow-up actions related to all backflow incidents i) Information on any contractors used to carry out any tasks involved with the CCC program, including contact information, service contract, etc. j) Public outreach or education materials for the previous three calendar years
8.2 - Methods of how data is maintained and/or stored
The District will maintain records using the following methods:
Item Method (Digital, hard copy, both, or other - describe) Hazard Assessments Digital and/or hard copy
BPA Information Digital and/or hard copy
Air Gap, Swivel-El Information
BPA field test reports Digital and/or hard copy
BPA Installation, Repair,
Replacement
Digital and/or hard copy
Certification information of BPA
testers and CCC Specialists
Digital and/or hard copy
Backflow Incident Documentation Digital and/or hard copy User Supervisors (if required) Digital and/or hard copy Public Outreach, Education
Materials
Digital and/or hard copy
CCC Program Contractor
information (if a contractor is used)
Digital and/or hard copy
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Section 9 - Backflow Incident Response, Reporting, and Notification
The PWS must develop and implement procedures for investigating and responding to suspected or actual backflow incidents in accordance with CCCPH Section 3.5.
The District CCC Specialist will investigate and respond to suspected backflow incidents, including but not limited to the following:
a) Consideration of complaints or reports of changes in water quality as possible incidents of backflow
b) Water quality sampling and pressure recording
c) Documentation of the investigation and any response and follow-up activities
9.1 - Backflow Incident Response Plan
The District CCC Specialist will participate in a backflow incident response plan that will include, but is not be limited to:
a) Notification of affected service area population;
b) Notification and coordination with other agencies, such as the State Water Board, and the local health jurisdiction;
c) Identification of the source of backflow substance;
d) Isolation of the source of backflow substance and the affected area(s); e) Mitigation measures to correct the problem;
f) Application of corrective actions to prevent future backflow occurrences; and g) Documentation of the backflow incident investigation, response, and follow-up actions
9.2 - Backflow Incident Notification
The District will notify the State Water Board and local health agencies of any known or suspected incident of backflow within 24 hours of the determination.
State Water Board – Division of Drinking Water Contact Information:
District 06 – Santa Barbara
Office Phone: (805) 566-1326
Emergency Phone: (805) 440-9627
If required by the State Water Board, the District will issue a Tier 1 Public Notification. The State Water Board may also require the District to submit a written incident report describing the details and affected area of the backflow incident, actions in response to the backflow incident, and follow up actions to prevent future backflow incidents.
A copy of the District Incident Response Plan is available for distribution and attached as Attachment C.
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Section 10.0 - Public Outreach and Education
The PWS must implement a CCC public outreach and education program element that includes educating PWS staff, customers, and the community about backflow protection and CCC. The PWS may implement this requirement through a variety of methods which may include providing information on CCC and backflow protection.
The District will distribute CCC education materials using any of the following methods:
a) Periodic Water Bill Inserts
b) Pamphlet Distribution
c) New Customer Documentation
d) Customer Emails
e) Annual Consumer Confidence Reports
f) Public Outreach Events
g) The District Website
h) Informational website(s) on CCC maintained by another entity and provided to the District customers
For residential customers, it is recommended that such education materials describe the cross - connection hazards in homes and the recommended assemblies or devices that should be installed by the homeowner to reduce the hazard to the public water system. The education program should emphasize the responsibility of the customer in preventing the contamination of the public water supply. Other education information distributed by the District can include, but not be limited to, the following:
a) Cross-connection hazards in general
b) Irrigation system hazards and corrective actions
c) Fire sprinkler cross-connection hazards
d) Point-of-use treatment (i.e. household softeners, reverse osmosis units) cross - connection hazards
e) Auxiliary water supply (i.e. privately -owned wells, graywater or other non- potable water use) cross-connection hazards
f) Importance of annual inspection and/or testing of backflow preventers g) Thermal expansion in hot water systems when backflow preventers are installed for premises isolation
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Section 11.0 - Local Entity Coordination
Per the CCCPH, the PWS must coordinate with applicable local entities that are involved in either CCC 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)
Ventura County Fire
Department
Alexander T.
Foskarino
(805) 389-9738
[email protected]
Simi Valley Police
Department
Dispatcher (805) 583-6950
Ventura County Sheriff’s
Department
Dispatcher (805) 654-9511
City of Simi Valley Building
& Safety
Johnny Lee 805-583-6885
[email protected]
County of Ventura Building
& Safety
Catherine Wilson (805) 654-3192
[email protected]
Ventura County
Environmental Health
Division
Ron Ventura (805) 654-3519
[email protected]
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Section 12.0 - Cross-Connection Control Plan Certification I certify that the information submitted in this plan is accurate and we will comply with the Cross- Connection Control Policy Handbook (effective date July 1, 2024).
Public Water System Representative
Name: Title:
Signature: Date:
Public Water System Designated Certified Cross-Connection Specialist Name: Marcos Ferreccio Title: Associate Engineer
Signature: Date:
38 Attachment A
Ordinance No. (TBD)
39 ORDINANCE NO. (TBD)
AN ORDINANCE OF THE BOARD OF DIRECTORS OF
VENTURA COUNTY WATERWORKS DISTRICT NO. 8
ADDING CHAPTER 15 TO TITLE 6 - SANITATION AND
HEALTH OF THE MUNICIPAL CODE OF THE CITY OF SIMI
VALLEY ESTABLISHING REQUIREMENTS FOR THE
INSTALLATION, MAINTENANCE, AND TESTING OF
BACKFLOW PREVENTION ASSEMBLIES AND THE
PROHIBITION OF CROSS-CONNECTIONS
THE BOARD OF DIRECTORS OF VENTURA COUNTY WATERWORKS DISTRICT NO. 8 DO ORDAIN AS FOLLOWS:
SECTION 1. Chapter 15, of Title 6, of the Simi Valley Municipal Code is hereby added as follows:
TITLE 6. SANITATION AND HEALTH CHAPTER 15. VENTURA COUNTY WATERWORKS DISTRICT NO. 8 (WWD8) BACKFLOW PREVENTION ASSEMBLIES INSTALLATION, MAINTENANCE AND TESTING; AND PROHIBITION OF CROSS - CONNECTIONS.
Article 1. – General
The Ventura County Waterworks District No. 8 (District) is a water purveyor that serves customers within the City of Simi Valley and some unincorporated areas of Ventura County. Prior to Assembly Bill 1671 and the Cross -Connection Control Policy Handbook (CCCPH), adopted December 19, 2023 and effective July 1, 2024, California’s regulations pertaining to cross -connection control were set forth in regulations in the California Code of Regulations (CCR), Title 17. 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)). All water purveyors are required to protect the quality and safety of their potable water supplies from potential backflow from customer properties into a water purveyor’s water distribution system. Such backflow can cause contamination or pollution of the potable water supply posing a public health risk. Furthermore, water purveyors are also required to prohibit cross-connections between a customer’s potable water system and other customer systems containing non-potable water or other fluids that could potentially backflow into the water purveyor’s potable water distribution system.
Section 6-15.01 – Purpose and Intent
The District shall protect the public water supply from contamination by implementation of a cross-connection control program. The program, or any portion thereof, may be implemented directly by the District or by means of a contract with a certified cross -connection control specialist.
The District’s cross- connection control program shall be for the purpose of addressing the requirements of CCCPH.
40 The purpose of this chapter is to:
a) Establish a cross-connection control program and meet the mandates of public health law concerning drinking water supplies as outlined in the Federal Safe Drinking Water Act and in CCCPH;
b) Protect the District’s potable water supply from actual and potential cross -connection by isolating within the property any contamination or pollution that could backflow into the water supply system via an undiscovered or unauthorized cross -connection on the property;
c) Provide for the maintenance of continuing cross -connection control program that will systematically and effectively prevent the contamination or pollution of all potable water systems.
d) Eliminate existing unprotected connections between drinking water systems and other sources of water that are not approved as potable and safe for human consumption;
e) Eliminate cross-connections between drinking water systems and other sources of water or process water used for any purpose whatsoever that may jeopardize the safety to the potable water system;
f) Prohibit cross-connections in the future;
The intent is to recognize that there are varying degrees of cross -connection hazards and to apply the principle that the degree of protection should be commensurate with the degree of hazard.
Section 6-15.02 – Definitions
The following terms are defined for the purpose of this ordinance and supported by additional definitions in Section 3.1.1 of the CCCPH:
a) “Backflow” shall mean the reverse flow of water, or any other fluid or substance or any combination or any mixture thereof, from the customer’s system into the District’s potable water distribution system.
b) “Board” shall mean the Board of Directors of the Ventura County Waterworks District No.
8. c) “Backflow Prevention Assembly” shall mean an assembly that protects the District’s potable distribution system from backflow.
d) “Certified tester” shall mean a person able to field test and make reports on backflow prevention assemblies possessing a valid certification issued by certifying organization recognized by the California State Water Resources Control Board (State Water Board). 41 e) “City” shall mean the City of Simi Valley.
f) “Cross-Connection” shall mean any actual or potential connection between the District’s potable water system and any source or system containing unapproved water or a substance that is not or cannot be approved as safe, wholesome, and potable.
g) “Cross-Connection Control Specialist” shall mean a person certified as a cross -connection control specialist and possessing a valid certification from a certifying organization by the State Water Board.
h) “Customer or responsible party” shall mean any person that either has applied for water service from the District, or owns or controls water piping or fixtures served by the District’s water supply. The terms customer and responsible party have the same meaning.
i) “Director” shall mean the City of Simi Valley’s Public Work’s Director.
j) “District” shall mean the Ventura County Waterworks District No. 8, or its authorized representative.
k) “District Engineer” shall mean the Assistant Public Works Director of Utilities Engineering of the Ventura County Waterworks District No. 8.
l) “District Manager” shall mean the Ventura County Waterworks District No. 8 Manager.
m) “Service Area” shall mean areas in which the Ventura County Waterworks District No. 8 provides potable water service within the City of Simi Valley and some unincorporated areas of Ventura County.
n) “Service Connection” shall mean the point of connection of a customer’s system to the District’s water system.
o) “Water system” shall mean the Ventura County Waterworks District No. 8 potable water system.
Section 6-15.03 – General Requirements
a) Backflow prevention assemblies shall be required per Section 6-15.04.
b) Backflow prevention assemblies must be approved by the University of Southern California’s Foundation for Cross-Connection Control and Hydraulic Research.
c) Backflow prevention assemblies are owned and maintained by the customer.
d) Customer shall have required backflow prevention assemblies installed in accordance with the District’s Water Design and Construction Standards, Section 6- 15.07 of this Ordinance, and the California Uniform Plumbing Code.
42 e) Customer shall be responsible for inspections, repairs, and proper testing of all backflow prevention assemblies installed on their property in accordance with Section 6- 15-.08 of this Ordinance.
f) Customer shall permit the District, the cross -connection control specialist , and/or a certified tester, to enter customer’s property within the normal working hours of the District, or in case of emergency, at any time, to test or inspect the backflow prevention assembly.
g) Customer shall be responsible for obtaining the required permits to install or replace a backflow prevention assembly.
h) Backflow prevention assemblies shall be installed on private property, as close as practical to the meter, but no further than ten (10) feet from the public -right-of way or District’s easement.
i) A property with multiple domestic service connections to the water system shall have a backflow prevention assembly installed on each service connection, if required. All service connections shall be protected to the highest degree found during the hazard assessment.
Section 6-15.04 – Hazard Assessments
The District has jurisdiction and maintains the water system up to and including the water meter that provides service to a property. All piping beyond the water meter, including backflow prevention assemblies, shall be the responsibility of the customer.
a) Per Section 3.2.1 of the CCCPH, an initial hazard assessment to evaluate the potential for backflow into a public water system must be conducted. The assessment will include an inspection of the customer’s property within its system service area.
The hazard assessment must consider:
1) The existence of cross-connections;
2) The type and use of materials handled and present, or likely to be, on the customer’s property;
3) The degree of piping system complexity and accessibility; 4) Access to auxiliary water supplies, pumping systems, or pressure systems; 5) 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.);
6) Customer’s property accessibility;
7) Any previous backflow incidents on the customer’s property; and 8) The requirements and information provided in the CCCPH.
43 Within five (5) business days from receiving notification, the water service customer shall grant designated / contract water staff access to the property and buildings. Failure to provide access may result in water termination.
b) Each hazard assessment must identify the degree of hazard to the public water systems distribution system as either a high hazard cross -connection, a low hazard cross connection, or having no hazard. Examples of some high hazard cross -connection activities may be found in Appendix D of the CCCPH.
c) The hazard assessment must determine whether an existing BPA, if any, provides adequate protection based on the degree of hazard.
d) Hazard assessments completed prior to the adoption of the CCCPH may be considered as an initial hazard assessment provided that such hazard assessments and associated backflow protection provide protection consistent with the CCCPH and the public water systems describes their review of these assessments in the Cross -Connection Control Plan required in CCCPH Section 3.1.4.
e) Subsequent to the initial hazard assessment described in subsection (a), a community water system must perform a hazard assessment under the following criteria:
1) If a customer’s property changes account holder, excluding single-family residences; 2) If a customer’s property is new or re-connected to the public water systems; 3) If evidence exists of changes in the activities or materials on a customer’s property; 4) If a backflow incident occurs from a customer’s property; 5) Periodically, as identified in the public water systems Cross -Connection Control Plan required pursuant to CCCPH section 3.1.4.;
6) If the State Water Board requests a hazard assessment of a customer’s property; 7) If the public water systems conclude an existing hazard assessment may no longer accurately represent the degree of hazard.
f) A cross-connection control specialist must review or conduct each initial and follow up hazard assessment pursuant to this section and make a written finding that, in the specialist’s judgment based on cross -connection control principles, the public water systems hazard assessment properly identified all hazards at the time of the assessment, the appropriate degree of hazards, and the corresponding backflow protection.
Section 6-15.05 – Temporary Water Service Connections
The District may require appropriate backflow prevention assemblies to be installed and tested for all temporary water service connections to eliminate the potential for any backflow.
Section 6-15.06 – Booster Pumps
For properties having private booster pumps to address low water pressure or special operations, the booster pump shall be equipped with a low -pressure cutoff switch designed to shut off the pump when the water pressure on the inlet side is 25 pounds-per-square-inch or lower.
Private booster pump installations within the City of Simi Valley shall be subject to approval by the Environmental Services Department, Building and Safety Division. Private booster pump 44 installations outside of the City of Simi Valley boundary, but within the District’s service area shall be subject to approval by the Ventura County Building and Safety Division.
Section 6-15.07 – Installation
a) Backflow prevention assemblies shall be installed in accordance with the CCCPH, the Waterworks District No. 8 Water and Design Construction Standards (WDCS), the California Uniform Plumbing Code, and the most recent edition of the USC Foundation for Cross - Connection Control and Hydraulic Research.
b) When a new water service is requested for a proposed development, the District will review the application to determine the required type of backflow prevention assembly. It shall be the customer’s responsibility and expense to have the required backflow prevention assembly installed. No connections shall be permitted between the water meter and the backflow prevention assembly.
c) An existing backflow prevention assembly that does not provide adequate protection for the degree of potential hazard from backflow must be replaced at the customer’s expense.
d) No modifications to, or removals of approved backflow prevention assemblies shall be permitted unless approved by the District in writing.
e) All newly installed and approved backflow prevention assemblies must be tested and certified as functioning properly prior to the water service being turned on.
Section 6-15.08 –Testing
a) Approved backflow prevention assemblies shall be tested by a certified tester using test procedures outlined in the most recent edition of the Manual of Cross -Connection Control published by the USC Foundation for Cross-Connection Control and Hydraulic Research.
b) Backflow prevention assemblies shall be tested at least annually, or more frequently if determined necessary by the cross -connection control specialist. The District shall notify customers when annual testing is required, and the notice shall contain the date when the test must be completed, and test results submitted.
c) Backflow prevention assemblies that fail to pass testing shall be repaired and retested immediately, at the expense of the customer. The backflow prevention assembly must not be placed in service unless the assembly is functioning as required.
d) For backflow prevention assemblies that fail to pass inspection and testing, the District reserves the right to require more frequent testing or to perform additional testing by a certified tester when the District determines it to be in the public interest. Customer shall bear the cost of additional tests.
e) If customers do not test their backflow prevention assembly and their assembly is out of compliance with the annual test requirement, the District reserves the right to have the 45 assembly tested by a certified tester and charge the customer accordingly. Charges shall consist of a penalty fee, an inspection fee, testing fee, and any associated costs of repairing/replacing the backflow prevention assembly.
f) The certified tester must complete and upload the assembly test report to the public water service backflow portal demonstrating testing and inspection compliance within 30 days of the annual notice. If the certified tester does not submit the test results within 30 days, the District shall assess a penalty fee and send a second notice to the customer. The second notice shall notify the customer that water service to the property will be terminated if test results are not submitted by the date specified on the second notice.
g) The customer shall at all times maintain the backflow prevention assembly in proper working order and provide unobstructed access to the District, cross -connection control specialist, and certified tester.
Section 6-15.09– Prohibition of Cross-Connections
a) Where a property has alternative water sources or operate processes that utilize non- potable water or other fluids, cross -connections from these sources or facilities are prohibited. For properties within the City boundary, the City of Simi Valley’s Building and Safety Division shall inspect and approve all on- site plumbing downstream of the District -required backflow prevention assemblies and ensure that there are no such cross -connections. For properties outside of the City boundary but within the District’s service area, the Ventura County Building and Safety Division shall conduct the inspection.
b) The customer shall secure a Building Permit from their respective Building and Safety Divisions to ensure the required inspection and approval prior to modifying on-site plumbing that may result in a cross-connection.
c) The cross-connection control specialist shall have access to inspect on- site facilities to check for cross -connections and to determine if the potable water system is protected from backflow.
Section 6-15.10– Penalties
a) For each water customer that fails to have a satisfactory hazard assessment performed, for each water customer that fails to have the appropriate required backflow prevention assembly installed or replaced, and for each backflow prevention assembly that is out of compliance with the annual test requirement, the District shall, as necessary, apply any of the following enforcement measures:
1) Deny or discontinue water service to a water user
2) Use of penalty fine(s) on water users, per the current fees in the City of Simi Valley’s Summary of Service of Charges
3) Install, inspect, field test, and/or maintain a BPA at a water user’s premises and charge the customer a penalty fee equivalent to the full cost recovery of all materials and staff time per the current fees in the City of Simi Valley’s Summary of Service of Charges 46 Attachment B
ASME A112.1.2-2012 (R2017) Table 1, Minimum Air Gaps
for Generally used Plumbing Fixtures
47 13F
ASME A112.1.2-2012(R2017) Table 1, Minimum Air Gaps for Generally used Plumbing Fixtures,1 page 4
TABLE 1
Minimum Air Gaps for Generally used Plumbing Fixtures4
FIXTURES WHERE NOT AFFECTED
BY SIDEWALLS1
(inches)
WHERE AFFECTED BY
SIDEWALLS2
(inches)
Effective opening3 not
greater than ½ of an inch
in diameter
1 11/2
Effective openings3 not
greater than ¾ of an inch
in diameter
11/2 21/4
Effective openings3 not
greater than 1 inch in
diameter
2 3
Effective openings3
greater than 1 inch in
diameter
Two times the diameter of
effective opening
Three times the diameter of
effective opening
For SI units: 1 inch = 25.4 mm
Notes:
1. Sidewalls, ribs, or similar obstructions do not affect air gaps where spaced from the inside edge of the spout opening at a distance exceeding three times the diameter of the effective opening for a single wall, or at a distance exceeding four times the effective opening for two intersecting walls.
2. Vertical walls, ribs, or similar obstructions extending from the water surface to or above the horizontal plane of the spout opening other than specified in Footnote 1 above. The effect of three or more such vertical walls or ribs has not been determined. In such cases, the air gap shall be measured from the top of the wall.
3. The effective opening shall be the minimum cross -sectional area at the seat of the control valve or the supply pipe or tubing that feeds the device or outlet.
Where two or more lines supply one outlet, the effective opening shall be the sum of the cross-sectional areas of the individual supply lines or the area of the single outlet, whichever is smaller.
4. Air gaps less than 1 inch (25.4 mm) shall be approved as a permanent part of a listed assembly that has been tested under actual backflow conditions with vacuums of 0 to 25 inches of mercury (85 kPa).
48 Appendix C
Ventura County Waterworks District No. 8 Backflow Incident Report
49 Ventura County Waterworks District Number 8
Backflow Incident Report
What is a backflow incident and what causes it?
Engineers design water systems so that water flows from the distribution system to customers. However, unusual conditions can cause the water to flow backwards—from a customer’s plumbing system into the public water system. Backflow can occur at any potential physical “cross connection” between a public water system or the customer’s water system and any source of liquid, solid, or gas that could contaminate the water supply.
Conditions That Cause Backflow
Backsiphonage: Occurs when pressure in the public water system drops below a customer’s plumbing system pressure. Backpressure: Occurs when pressure in a customer’s
plumbing system rises above the public water supply pressure.
How do I know whether backflow occurred?
If a backflow incident occurs, customers must contact the District to express concerns about degraded water quality or loss of pressure. You should respond quickly and investigate all potential backflow incidents. Customer complaints and your own observations may be clues that a backflow event occurred. Discolored or unusual looking water. Listen for words such as discolored, cloudy, soapy, foamy, or oily.
Taste and odor problems. Listen for words such as fuel, chemical, medicinal, or salty, especially after a low-pressure event.
Low or no chlorine residual in the distribution system. Measure and record free chlorine residual at locations around a pressure-loss event or water quality complaint. Lower residuals may mean chlorine is reacting with substances that entered the water system.
50 Backflow Incident Report Form
Reported By:
Mailing Address:
State:
Reporting Agency:
Date of Incident:
General Location (Street, etc.):
Zip Code:
Title:
Time of Occurrence:
City:
Phone:
Report Date:
Backflow Originated From:
Name of Premises: __________________________________________________________________________________ Type of Business: __________________________________________________________________________________ Address: ______________________________ City: ___________________ Zip Code: ______________ Description of Contaminants: (Attach Chemical Analysis if available) _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ Distribution of Contaminants:
Contained within customer’s premises: Yes _____ No _____ Number of persons affected (estimated): _________
Effect of Contamination:
Illness Reported:
_________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ Physical Irritation Reported:
_________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________
51 Backflow Incident Report:
Cross-Connection Source of Contaminant (boiler, chemical pump, irrigation system, etc.):
_________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________ Cause of Backflow (main break, fire flow, etc.):
_________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________ Corrective Action Taken to Restore Water Quality (main flushing, disinfection, etc.):
_________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________ Corrective Action Ordered to Eliminate or Protect from Cross-Connection (type of backflow preventer , location, etc.):
_________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________ Previous Cross-Connection Survey of Premises :
Date: __________________ By: ___________________________________ Type of Backflow Prevention Isolating the Premises :
RPZ: □ RPDC: □ DCVA: □ DCDC: □ PVB: □ SVB: □
AVB: □ AirGap: □ None: □ Other Type:
Date of Latest Test of Assembly: _______________ Tested by: __________________________________ Testing Company Information: __________________________________________________________ Notification to Water Department's Cross-Connection Control Division Date: __________ Time: __________ Person Notified: _____________________________________ Attach sheets with additional information, sketches, and/or media information, and mail to:
Ventura County Waterworks District 8
2929 Tapo Canyon Rd.
Simi Valley, CA 93063
52 Appendix D
Residential Sprinkler Backflow
Prevention Assembly (BPA)
Exemption
53 Fire Sprinkler Systems at Residential User Premises
Per CCCPH Section 3.2.2(e)(3), a BPA is not necessary for a low hazard fire protection system on a residential user premises if the following criteria are satisfied:
A. the us
er premises has only one service connection to the PWS
B. a single service line onto the user 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
C. a single, water industry standard, water meter is provided to measure combined domestic flow and fire protection system flow
D. the fire protection system is constructed of piping materials certified as meeting NSF/ANSI Standard 61
E. the fire protection system’s piping is looped within the structure and is connected to one or more routinely used fixtures (such as a water closet) to prevent stagnant water 54