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Air Gap Agreement
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Enter Hazard ID Number
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I will use the air gap method when filling my pool, hot tub, pond, fountain, or other vessel.
I intend to have an RP backflow preventer installed at my personal cost.
Confirm the following:
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I agree to maintain an air gap, according to LDH regulations, when filling my pool, hot tub, pond, fountain, or other vessel.
I understand that an RP backflow preventer will be required should I not comply with these filling requirements.
Confirm the following:
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I agree that upon installation, I will notify ACUD 1 or their authorized contractor of the make, model, serial number, and initial test report of the RP backflow preventer.
I agree that I will have the RP inspected and tested annually by an approved WSPS certified plumber or general tester, according to LDH regulations, and will submit the test report to ACUD 1 or their authorized contractor.
By typing my name, I certify that I am authorized to agree to the above terms and conditions.
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Backflow Prevention Services, LLC