Backflow Protection Exception Application

Information is needed for any building system or process that uses water. This could be a heating or cooling system, fire sprinklers, a lawn irrigation system, etc. Additionally, you must provide information for toxic materials that are used or stored on site. We recommend having someone who is familiar with the basics of your plumbing system, HVAC system, and other water usage complete the form.

Mail: Columbus Division of Water
Backflow Compliance Office
918 Dublin Rd
Columbus, OH 43215

Email: backflowsurvey@columbus.gov

Fax: 614-724-0790

If completing the application for a new tap or modified connection to the public water system, submit it with your proposed Water Service Plan or Service Connection Permit Application.

This is based on the location of the meter that serves the property. You can find it on your water bill. It may not match the building address, particularly if the meter is in a vault at the property line, or in a multi-unit building such as a strip mall.

The account number can be found on your water bill or letters sent from the Backflow Compliance Office.

Refer to the water bill or notices from the Backflow Compliance Office. If the name on the account is incorrect please call 614-645-8276 or e-mail utilityleadrep@columbus.gov.

Please provide a phone number so we can contact you if we have questions about your request.

These only feed private fire hydrants and/or fire sprinkler/suppression systems. These will appear on your bill as Service Type "Fire". Since they are intended for infrequent, but high flow they are metered and billed differently than other service lines. Fire-only service lines are not eligible for an exception. Sites with fire-only service lines will typically have a separate water service line for domestic use.

These service lines feed all uses other than fire protection. Exceptions may only be requested for domestic only water service lines.

A combined service line supplies water for domestic uses and provides water for fire protection (private fire hydrants or fire suppression systems). These lines are not eligible for an exception.

The meter size is often stamped on the body of the meter. The service size is the diameter of the supply pipe from the city water main before the meter setting. If possible measure the service line between where it comes through the floor/wall and the meter setting. Possible sizes are 5/8", ¾", 1", 1 ½", 2", 3", 4", 6", 8", 10", or 12". In some cases the meter may be 1 size smaller than the service line.

Residential means use of a property for a dwelling unit and ordinary associated uses only. A dwelling unit is a single, self-contained unit providing independent living facilities for one or more individuals and which contains eating, living, sanitary and sleeping areas and one cooking facility, all for exclusive use by the occupant. Examples include apartments, condos, single family homes, manufactured homes, etc. Nursing homes and convalescent centers are also considered residential. If you check "Residential only" go to Question 2 and skip Question 3.

Non-residential means any property that is not used solely for residential use. Mixed use properties consisting of both residential and non-residential uses served by the same water service line(s) are considered non-residential by our office. If you check "Non-residential or mixed use", skip Question 2 and go to Question 3.

Skip question 2, 2a, and 2b if you checked "Non-residential or mixed use"

2)How many dwelling units are served by this account? If you checked "Residential only" in Question 1 you must choose one of the options in Question 2. For Questions 2 and 2a, count the units receiving domestic water service (for consumption, bathing, etc.). If your site also has a separate water service line that is for fire protection, only consider the domestic water service line in your response to Questions 2 and 2a.

2a) Do 5 or more dwelling units share the same City of Columbus water meter?
If 5 or more dwelling units share the same City of Columbus water meter for domestic water service (consumption, bathing, etc.) please check "Yes." If a unit is individually metered by the City of Columbus in most cases it will receive its own water bill from the Division of Water.

2b) Please check Yes or No as applicable

Skip question 3 and 3a if you checked "Residential use only"

3) Is the site 100% owner occupied? If any tenants, check "No."
Owner occupied means the customer named on the account is also the legal owner of the entire premise served by the water service line, the customer controls water use at the premise, and no part of said premise is leased, sublet, etc. If the property is a vacant rental property please check "No."

3a) If you checked non-residential for Question 1, you must select at least one box from this list. Select the description(s) that best applies to the property. If none of the descriptions describe your property please select "Other" and write in the description.

Check "Yes" if you have a buried irrigation system that is connected to your property's plumbing system. Temporary sprinkler systems that are attached to a garden hose on the ground are not considered a buried irrigation system.

Water powered sump pumps use the flow of water from your private plumbing system to siphon water out of a sump pit. These are typically a backup system to your electric or battery powered sump pump.

A geothermal heating or cooling system exchanges heat energy with the ground to heat or cool your property. It may include a well or use fluids other than water.

Do you use any water that is not provided by the City of Columbus, Division of Water? A second source of water that has pumps or pipes to allow for use of the water is referred to as an auxiliary water system. Examples include wells with a pump, a pond with a hose connection for the fire department, or a rooftop rainwater harvesting system that uses water for flushing toilets.

If you have an auxiliary water system, either permanent or intermittent, please check "Yes" and explain.

8) Does your property have a fire suppression system and/or a private fire hydrant(s) that uses city water? If any portion of the property is protected by a water based fire sprinkler check yes. Private fire hydrants are typically painted red.

8a) If the fire hydrants and/or fire suppression system are supplied by a fire-only water service line check "No".

Some chillers utilize water to cool a building or piece of equipment.

10) Boilers, steam systems and other types of radiant heating systems often rely on hot water in order to supply heat. If your radiant heating system is permanently sealed and is not connected to the potable water system, do not include it in your response.

10a) If so, can conditioning chemicals be added to the system?
Examples of these chemicals are alkalinity builders, condensate line protectors, multi-functional treatments, oxygen scavengers, scale and corrosion inhibitors, sludge conditioners, etc. If any of these additives could be used in the system please check yes, even if you currently are not using additives.

11) Please do not include pools intended for temporary use that are set up and filled for short-term use (several days) before being drained, and that do not use added disinfectants (e.g. chlorine).

11a) How is it filled?
If a temporary hose or other water line is needed to fill the hot tub or pool then check the box next to "hose." If a permanent water supply line to the hot tub or pool is installed then check the box next to "permanent plumbing connection."

11b) Leave this blank if filled using a hose

If so, please describe.

Warning labels may contain skull and crossbones and/or the words toxic or danger.
If "yes," please describe in this section of the questionnaire.

Note: Toxic or dangerous chemicals can have severe consequences on the public's health if they are drawn into the potable water system. Safety Data Sheets (SDS) are another great source for determining if a substance is toxic or dangerous.