CITY OF t101• All-Amet1caCIIY

_ _ F_O_R_T_L_A_U_D_ER_D_A_L_E _______ , 111.' HYDRANT METER CHECKLIST:

Hydrant Meter Application

Email address provided

Blue Cap Hydrant List

Backflow Informational Sheet (Requirement)

Backflow Device (Reduced Pressure Zone - RPZ) *The backflow device must be presented to City staff in order to pick up the hydrant meter at Public Works Department located at: 949 NW 38th Street, Fort Lauderdale, FL 33309.

*Backflow Device (Reduced Pressure Zone - RPZ) to fit onto the Hydrant meter outlet. The hydrant outlet is composed of a 2-1/2” NPSH male nipple.

Obtained Hydrant Meter from Public Works Department

Received copy of Backflow Test Report *Backflow Test Report shall be submitted within 30 days to: Keith Chin email:kchin@fortlauderdale.gov or Elaine Velez email: evelez@fortlauderdale.gov

*Failure to submit a backflow test report to the City of Fort Lauderdale, the City reserves the right to recollect the hydrant meter at any given time.

PUBLIC WORKS DEPARTMENT Page 1 of 1 949 N.W. 38TH STREET, FORT LAUDERDALE, FLORIDA 33309

TELEPHONE (954) 828-8000, FAX (954) 828- 7897 Equal Opportunity Employer WWW.FORTLAUDERDALE.GOV Printed On Recycled Paper.

~ CITYOF

_\e!;J FORT LAUDERDALE t,0,1 mr

____________________________________________________________________

APPLICATION/RENEWAL FOR HYDRANT METER PERMIT

Tax ID #:________________ Permit #: ________________ Account #:_______________

Name of Firm: ______________________ Date: _____________________

Contact Person: ________________________________________________________

Address of Firm: ________________________________________________________

Business Owner or Responsible Party:_______________________________________

Type of Business: __________________________ Business License#: ____________

Office Phone #: _____________________ Cell Phone #:________________________

E-mail Address: ________________________________________________________

Billing Address: ________________________________________________________

Vehicle information (applicable only if meter is used on a vehicle)

Make: ___________ Model: ___________Serial#: __________License#: _______

Street address of hydrant If meter is not to be used on a vehicle:

How long do you anticipate using this meter: _____________________________

TO BE COMPLETED BY CITY PERSONNEL Meter Deposit $________

Person collecting deposit:______________________ Date:_________________

Meter Size: _____________________(inches) Meter No:___________________

1. Reading of meters and inspection of cross connection control will be performed monthly at the City of Fort Lauderdale’s Public Works Department located at: 949 NW 38 Street, Fort Lauderdale, FL 33309.

2. Failure to have your meter read monthly or to pay bills when due, will result in issuance of delinquency notice. Continued non-compliance will result in revocation of permit, forfeiture of the deposit and/or loss of the right to use hydrant supplied water as described in Sec. 28-147 in the City of Fort Lauderdale Code of Ordinances.

Page 1 of 2 PUBLIC WORKS DEPARTMENT 949 N.W. 38TH STREET, FORT LAUDERDALE, FLORIDA 33309

TELEPHONE (954) 828-8000, FAX (954) 828- 7897 Equal Opportunity Employer WWW.FORTLAUDERDALE.GOV Printed On Recycled Paper.

----3. Meters are issued with a single check valve backflow prevention device which must

be attached at all times. In addition, a Reduced Pressure Zone assembly (RPZ) must be installed by the responsible party for fixed locations or mobile meters that do not have a fixed air gap. Should the single check valve device be detached from the meter, the meter must be returned to the City and the account will be charged a fee for the cost of a new device. The fee will be determined by the Public Works Department – Utilities Division, and issuance of another meter will be at the discretion of the City. See below affidavit.

4. Billing statements will be submitted monthly to the applicant. A fixed non-refundable monthly charge per meter will be applied, in addition to the commodity charge for the amount of water consumed, in accordance with the City of Fort Lauderdale Municipal Code Section 28-143.

5. Meters issued to vehicles will be supplied with a list of blue capped hydrants. These are the only hydrants to be used without prior approval by the Public Works Department. Use of undesignated hydrants may result in revocation of permit. If issued meter is not installed on a vehicle, only the hydrant designated for use is allowed.

6. Meter must be in place with seal unbroken when obtaining water from City fire hydrants. Violation of this rule will result in a fine of $500.00, imposed of a special deposit and/or permanent revocation of permit. Cases of use of hydrants without meter in place may be referred to the City’s Police and Legal Department for prosecution in accordance with the City of Fort Lauderdale Municipal Code Section 28-148.

7. Any violation of Chapter 28 is subject to penalty and fines between $150-$250 in accordance with the City of Fort Lauderdale Municipal Code Section 11-25.

8. Permit is in effect for one year from the application date and shall be renewed 30 days prior to expiration date.

9. Applicant agrees to abide by the City of Fort Lauderdale Code of Ordinances, applicable sections, and provisions set forth by this application.

___________________________________________________ Date: ______________ (Owner’s notarized signature required) NOTE: If the Property Owner is a corporate entity, only those authorized individuals as specified by Florida law may sign on behalf of the corporate entity. Evidence of said corporate authority may be required by the City.

STATE OF FLORIDA COUNTY OF BROWARD

The foregoing instrument was acknowledged before me this _________day of______________________20___,

by_________________________________________________. He/she is personally

known to me or who has produced________________________________ (type of identification) as identification.

NOTARY’S SEAL: ________________________________ NOTARY PUBLIC, STATE OF FLORIDA

Page 2 of 2

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BLUE CAP HYDRANTS LIST

The following is a list of those hydrants that may be used by permitted vehicles and are designated for this purpose by blue pumper caps. If a discrepancy is found at any time between this list and the specially marked hydrant, disregard the list and use only those that have the blue cap in place. You will be notified by mail of any changes to the list as they occur. Use of any non-blue cap hydrants is strictly prohibited without written authorization from the City of Fort Lauderdale.

SECTION HYDRANT# ADDRESS

Southeast 4750 1556 Ponce Deleon Drive

3584 SE 4th Ave. & SE 26th Street

2364 Sunset Drive at Las Olas Blvd.

Northeast 2255 2500 NE 9th Street

2158 NE 9th Ave. & NE 6th Street

2198 N. Victoria Park Rd. & NE 3rd Ct

0615 NE 17th Ave. & NE 50th Ct. (North Hydrant)

9031 thNE 16th St. & NE 11 Ave.

1334 NE 51st St. & Bayview Drive

7205 Center Ave. & Oakland Park Blvd.

1166 Middle River Dr. & NE 14th Street

9780 2002 NE 16th Street

Southwest 8051 800 SW 2ih Street

7450 Frontage Road & SW 22 Ave. (North side of Davie Blvd.)

10329 Frontage Road & SW 22 Ave. (South side of Davie Blvd.)

3390 SW 9th Ave. & SW 14th Court

3079 SW 36th Terrace & SW 16th Court

8514 SW 14 Ave. & SW 2nd Court

9037 th SW 12 Ave. & SW 2 Street

4829 th

SW 28th Ave. & SW 10 Street

4753 2601 SW 11th Court

Northwest 7875 th

NW 31st Ave. & NW 17 Court

1962 108 NW 20th Avenue

0135 3000 W est Prospect Road

If there are any questions regarding this list, please contact Customer Service at 954-828-8000.

ATTENTION: Permit is in force for a maximum of one year only. Reapplication for permit must be done during the last month of its validity.

LIST REVISED April 2018

-~-sfr(pf~ che¢k valy&·-~aqkflow·pr.,v~r,JJ~ti -d$v.l~:-iii:t,til•·•tt~~,d at ttU t1me,. tit a.d~'l~!PU, , R,ducfid P"re.s~ur.e.z<in:e a,niJT~!y--(-RP.!)-musfte i'n~Jtlle.:(f by th, · fflPOtisf~I~·p·arttf.or fl.Jed .hydrant.Jq,catJb11s or mob1Je:" bydral1t mete.rs th~t do not , hav♦, a. fixed air ·gap.

• -F~lfure to -~a:ve your meter read month.'fy or to p_ay ~ills when due, will result "in i$S.\lan!;:_$ b.f.-deJJn·queniy n~tJct$,

• e-ontln:ued n<itH;ompfia·11ce wf,11 r~su.lt In reyo-c~tion. of permit, forfelt_ure of the. d:epo:$11:aod/(jr los, ofth~ r:lgllH~, us~·hy(l,r~n.t ~QppU~~water ·as d.escrlbed In Sec.. 28-147111 the GJty of Fc>rt (.;a.utierdaft·¢J;>~e ofOrdtn~h,ces;

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It is illegal and dangerous to improperly use a fre hydrant Violators face stiff penalties and legal liability

The City of Fort Lauderdale has a process for allowing tanker trucks, contractors and other permitted customers to use designated fre hydrants as a temporary water supply under Chapters 28-172 and 28-153 of the City Municipal Code.

Applicants for a fre hydrant meter are required to sign an afdavit agreeing to abide by the City of Fort Lauderdale Code of Ordinances and all requirements for the issuance of meters. Any damaged or malfunctioning City equipment must be immediately returned to the City.

Upon approval of application and afdavit, hydrant meters are issued to the commercial customer for either a fxed hydrant location or mobile use for tanker trucks and trailers. The use of these meters must provide a specifc level of protection from contamination for the public water system.

Existing “Blue Cap”

Hydrant Water Meter

(Supplied by City) Reduced Pressure Zone (RPZ)

Back˜ow Assembly (Supplied by Contractor)

Flow

Illustration A

Fixed hydrant locations, such as construction sites or businesses, must have a reduced pressure zone assembly (RPZ) and supply a test report once installed (see illustration A). It is the responsibility of the meter user to purchase and install the RPZ assembly. This equipment, which protects Fort Lauderdale’s water distribution system from potential contamination, is the only equipment permitted for use on a City fre hydrant at fxed location hydrants.

Pipe Permanently Air Gap Attached to Tank (See Detail)

Hose Connection

Air Gap Detail Air Gap = 2 x “D”

(min. 1 inch) Flow

Diameter - “D”

Illustration B

Water trucks are required to have an air gap separation, which is a physical separation between the discharge end of a fre hydrant and an open or non-pressure receiving tank (see illustration B). Any water truck not equipped with a permanent air gap system is required to utilize a RPZ assembly. It is the responsibility of the meter user to purchase and install the RPZ assembly and supply a test report. Meters are issued with a list of addresses for the location of blue capped hydrants throughout the City. These blue capped hydrants are the only hydrants to be used without prior approval of the City’s Public Works Department.

Federal, state and local laws require Cross Connection Control Programs to protect public safety. Violators of fre hydrant safety regulations above face fnes up to $250 per day as well as potential criminal penalties, legal liability and civil damages for a backfow incident including revocation of the permitted meter use.

For more information about the City’s comprehensive Cross Connection Control Program, visit www.fortlauderdale.gov/backfow or call 954-828-8000.

If you would like this publication in an alternate format please call (954) 828-4755 or email publicaffairs@fortlauderdale.gov.

clkflow Prevent ion Assembly Test Report -Service Addr ess

Permit#:

Check if Com!d Corrections

Account # : '

Meter # : M aDing Address

Serial # : ~tanufacw rer:

M odel: Type : Size:

Location:

Test Du. No uter than:

El<is1ing B New

Removed § I Commercial D Industrial D Residential D Municipal DI Domestic O Irrigation O Rre D Replaced

R edu c e d Pre s s ure Pri n c iple Assem b l y Air G apR equired Separation Yes No

D o u b l e C h e ck Valve Assembly PVB/SVB Check Valve #1 Check Valve #2 Re-lief Valv e- Air In let C h eck Valve

Initial Test

Date leaked Leaked Closed T ig ht 0 Close d Trght Diel not open Did not open Le aked T ime

Pass Fail Held at --- PSlD Held at --- PSID Opened at _ _ PSID Opened at __ PSID I-le-Id at --- PS ID

Repairs C leaned Rubber K i1 E] Date Rebuild

T ime Rep laced B Other

Final Test

Date C losed T ight 0 Cl osed Tight T ime

~ass Q Fail ~ lrflat _ PSID Held al -- PSID O pened at __ PS ID Opened at __ PSID Held al ---PSID __ , , .. . .._ 1,~ ,

Yes No

Proper Installation D RV Exercised

D I certify a':I information on lhis ,eport is true and accurate. acknowledging, tha1 incompete repoos will not be accepted. Servicoe Restored tJ tl

Please Print i2 Sootoif Tight tl tl

liestet Company Line Pressure

Certification# Phone Bypass M eter

Expire- Test Kil Serial # Reading

Sjgnature Calibration Date tl I certify tha.1 I am a. s1ate fire marsh certfied to test bacldlow assemblies on fire mes. Please Print. T est Kit M fg

fire Tester Company

Certification # Expire T e-st Kit Model

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WE BUILD COMMUN TY

SUSTAINABLE DEVELOPMENT – BUILDING SERVICES

BACKFLOW PREVENTION ASSEMBLY TEST REPORT

Rev: 1 | Revision Date: 2/23/2017 | Print Date: 2/23/2017

I.D. Number: BPATR

Page 1 of 1 Approval by: John Travers, Building Official

Uncontrolled in hard copy unless otherwise marked