SUBJECT: Completing the Backflow Prevention
Service Application (BSA)
June 11, 1999
Charlotte-Mecklenburg Utilities (CMUD) requires that a completed Backflow Prevention
Service Application (BSA) be provided for all CMUD-required backflow preventer
installations. Projects involving plan review require the BSA as one of the documents to
be submitted with plans to Mecklenburg County Engineering & Building Standards
Department. Plans can not be approved for permitting without the required BSA.
When completing the BSA, it is recommended, and often necessary, to get more
information from others involved in the project, such as the plumbing/mechanical
designer, the fire sprinkler system designer, the architect, the owner, and even the
occupant. Complete accurate information is vitally important. Often, it is an Aoperations@
person within the occupant company=s organization that has the most complete
knowledge of equipment that is or will be connected to the water system(s) and other
water-use activities.
Usually, information on the fire, domestic, and irrigation systems for a site can all be
provided using the different sections of a single BSA form. However, if more than one of
the same type service is involved for one address (for example, two domestic meters),
please submit a separate BSA for the second service.
Before submitting the BSA, please make sure that all “yes/no” questions are answered
for each water service affected by the BP installation(s) and that all other requested
information is provided. If the contractor responsible for the work is not known, please
indicate so, e.g. “not known at this time.” The box in the lower right-hand corner of the
sheet is “For CMUD Use Only;” please leave it blank.
Signature of the responsible individual is required. Note that the backflow prevention
requirement is subject to change if the information provided in the BSA is found to be
inaccurate or if water-use activities change.
Thank-you for your cooperation. If you have any questions about this matter, please call
Bob Briggs at (704) 336-2997.
Charlotte-Mecklenburg Utilities
System Protection Division at 5100 Brookshire Boulevard, Charlotte, NC 28216 704/399-2221