Full Text
PUBLIC WORKS DEPARTMENT 80 Columbia Ave Marysville, WA 98270 (360)363-8100 (360)651-5099 Fax hydrantusepermit.app.2010.utilites.wrd SITE FIRE HYDRANT UTILIZATION PERMIT APPLICATION AND HYDRANT BACKFLOW PREVENTION ASSEMBLY / METER LOAN AGREEMENT FEES AND INSTRUCTIONS FEE SCHEDULE* Deposit $1200.00 (refundable) Set-up fee $50.00 (non-refundable) rental $50.00 (non-refundable) Usage $3.50 per 1000 gallons The applicable hydrant use fee, water consumption fee, and any costs to repair or replace City equipment or property will be deducted from the original deposit prior to refund. INSTRUCTIONS The maximum length of time a meter and backflow assembly (BFA) can be checked out is one year. If a meter and BFA is needed for a period exceeding one year, a new meter and BFA will be issued, and the original unit must be returned for inspection and maintenance. The City will provide the customer a fire hydrant meter and gate valve, a section of fire hose, a hydrant wrench, a double check valve assembly (DCVA) or a reduced pressure back flow assembly (RPBA) according to the need, adapters for either a fire or garden hose, and instructions (as shown below) for proper installation. The deposit shall be refunded after the equipment has been returned in good condition and inspected by Utilities personnel, and all charges are paid. 1. Attach the meter to the designated hydrant outlet. 2. Connect the fire hose to the meter at one end, and to the backflow prevention assembly at the other end. Observe the directional arrows on the backflow assembly. 3. With the 2-inch control valve closed, use the hydrant wrench to open and close the hydrant. The hydrant must be in the full open position while using it. 4. The control valve on the meter MUST be used to prevent damage to the hydrant and to the water distribution system. Always open and close the control valve slowly to prevent surges or water hammer that could cause damage to the water system. *Per Appendix C, Fire Hydrant Utilization Program/July 2002 ---PAGE BREAK--- PUBLIC WORKS DEPARTMENT 80 Columbia Ave Marysville, WA 98270 (360)363-8100 (360)651-5099 Fax hydrantusepermit.app.2010.utilites.wrd HYDRANT METER CHECKOUT FORM and PERMIT PERMIT HOLDER INFORMATION Date Name: Contact: Phone: Contact: Phone: Address: Deposit rec'd Check # Rec'd by METER INFORMATION Designated Hydrant Location Estimated Return Date The CCS should ensure that the Site Fire Hydrant Utilization Permit holder receives applicable items as marked below and understands the instructions for proper installation and use. Meter With Control Valve, Handle, Meter number and Adapters. ¾ inch – 1 inch – 2 inch – Circle applicable size 2-1/2-inch Fire Hose Serial number For Low Hazard Use: Double Check Valve Assembly with Serial number Female to Hydrant Adapter Fitting ¾ inch - 1 inch - 2 inch - Circle applicable size For High Hazard Use: Reduced Pressure Backflow Assembly with Serial number Female to Hydrant Adapter Fitting ¾ inch - 1 inch - 2 inch - Circle applicable size Hydrant Valve Wrench Serial number 2-inch Male IPT to Hydrant Adapter Fitting Serial number 2-inch x 3/4-inch Bushing with 3/4-inch Serial number Garden Hose Adapter Fitting 2-inch Control Valve (Gate Valve) with Serial number Adapter Fittings Additional equipment/comments: ---PAGE BREAK--- PUBLIC WORKS DEPARTMENT 80 Columbia Ave Marysville, WA 98270 (360)363-8100 (360)651-5099 Fax hydrantusepermit.app.2010.utilites.wrd STATEMENT OF UNDERSTANDING The undersigned applicant hereby agrees to hold and save harmless the City of Marysville from any and all claims for damages, costs, expenses or causes of action that may arise of installation and maintenance of the improvement or other equipment use hereto applied. The undersigned further agrees to remove the equipment and return it to the City of Marysville upon notice from the City and agrees to reimburse the City for loss or damage to the assembly or city property. I have received the components specified and understand the instructions for their use. I understand this permit expires in one year. Issue Date Expiration Date Signature of Permit Holder METER READ Checked out by Meter reading Date Checked in by Meter reading Date Incoming Condition/Additional Comments: