Form GEN236, Application for Approval of Backflow Prevention Assemblies, is the New York City Department of Environmental Protection (DEP) form that a Professional Engineer (PE) or Registered Architect (RA) uses to get a property's backflow prevention plans approved. DEP's Cross-Connection Control Unit reviews it before any device is installed. It is one of several water and sewer forms DEP publishes, and paper copies can be requested by mail through NYC 311. On this page you can fill out the form online on FillingPDF and download or print the completed PDF; DEP publishes the original at nyc.gov.
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What is GEN236?
Form GEN236, Application for Approval of Backflow Prevention Assemblies, is the NYC Department of Environmental Protection (DEP) form on which a Professional Engineer or Registered Architect applies for approval of the backflow prevention plans for a property's water service connections.
The form is issued by DEP's Bureau of Water and Sewer Operations and reviewed by its Cross-Connection Control Unit. DEP's cross-connection controls page lists it as the Backflow Prevention Device Approval Form. The instructions printed with it call it the application for approval of containment backflow prevention assemblies, and the approval is valid for two years from the approval date.
The form records the facility's block and lot, where each assembly will sit, the manufacturer, model, size and type of each assembly, the number of fire, domestic and combined services, the type of submission, the design professional's license, the water pressure at the point of connection, the estimated installation cost and the assessed degree of health hazard.
It is only the plan-approval application. DEP uses separate forms to submit initial and annual backflow test results, to self-certify a domestic-service-line installation plan, and to self-certify an exemption for a facility with one domestic service line. Item 14 is for DEP use only.
Who needs to file GEN236?
Professional Engineers (PE) and Registered Architects (RA) fill out and sign Form GEN236 to apply for approval of backflow prevention device plans. DEP's page says a property owner who must install a device hires a PE or RA to prepare the plan, and the PE or RA sends it to DEP for approval.
The property owner or customer also takes part: item 7 asks for the owner's name, title, phone number, full mailing address and an original ink signature.
DEP says certain properties must use backflow prevention devices unless DEP grants a specific exemption. Examples on its list include properties with in-ground irrigation sprinklers or swimming pools, premises with multiple water service lines, hospitals and clinics, laundries, commercial car washes, auto repair shops, supermarkets, schools and colleges, and premises with commercial kitchens or groundwater wells.
If your property type is not on DEP's list and you have a question about your legal requirements, DEP asks you to call 311.
A facility with only one domestic service line may not need this form: DEP provides separate self-certification forms for that case.
When to file GEN236
File Form GEN236 before the device is installed. DEP's procedure has the PE or RA send the plan to DEP for approval; if the plans are approved, DEP notifies the owner by mail, and only then is a Licensed Master Plumber hired to install the device.
An approval is valid for two years from the approval date, as printed on the form. The form sets no other filing deadline.
Testing comes after installation and is reported on a separate test form. DEP says a signed initial test report is due within 30 days of installation, and the device must be tested every 12 months after that.
Documents you need
- Two original copies of Form GEN236, each with the original ink signature and seal of the PE or RA (item 10) and the owner's original ink signature (item 7); photocopies and electronic images are not accepted.
- Two copies of all plans, engineering reports and supporting materials, submitted with the two original forms.
- Fee payment for each water service connection, attached to the form as a check or money order payable to NYC Water Board.
- Additional sheets, only if the form lacks room (for example, to explain which buildings belong to the lot); mark them "Continued on back" or "See Additional Sheets", and label, originally sign and stamp them.
How to fill out GEN236
Print or type every entry
Print or type all entries except signatures, and complete items 0 through 13. Write N.A. in any item that does not apply to the proposed plans.
Identify the facility and lot
Enter block (0), lot (0a) and any tentative lot (0b), then the facility name (1), county (2), street address, city, state and ZIP code (3, 3a to 3c), and the facility contact person and phone (4, 4a). Work lot by lot.
Locate and describe each assembly
In item 5, give the exact location of each assembly and the floor or space it is in. In item 6, enter the manufacturer, full model number, size and type of each backflow prevention assembly; attach sheets if needed.
Count services and buildings
Enter the number of fire, domestic and combined services for the entire lot in 5a, 5b and 5c. Item 5d is their total, and 5e is the total number of buildings in the lot.
Complete the property owner block
In item 7, enter the owner's name, title, phone number and full mailing address. The owner signs and dates in original ink.
Mark the type of submission
In item 8, check As-Built, Initial Assembly Installation or Replace Existing Device. Then check the boxes in 8a (New Service or Exist. Service) and 8b (New Building, New Extension, Major Renovation, Existing Building or Other).
Enter the design professional details
In item 9, print the name and full mailing address of the engineer or architect, using the person's name rather than the firm's. In item 10, enter the NYS license number and check PE or RA; in 10a to 10c add phone, date signed and email, then sign and seal.
Add pressure and installation cost
In item 11, enter the maximum, average and minimum water system pressure in psi at the point of connection, as per the DEP Hydrant Flow Test. In item 12, enter the estimated installation cost.
State the degree of health hazard
In item 13, check Hazardous, Non-Hazardous with Hazardous Fixtures or Aesthetically Objectionable. List the processes or reasons that led to the degree you checked.
Leave the Department section blank
Item 14 and the DEP representative's signature block are for Department use only. Do not enter anything there.
Review, sign and download the PDF
Check that no item is blank and every signature and seal is in place. Download or print the completed PDF from FillingPDF, sign both copies in original ink and assemble the package described under How to submit.
How to submit GEN236
Submit Form GEN236 on paper to the DEP Cross-Connection Control Unit. The form names no online or in-person channel for this application.
- Mail or deliver to: New York City, Department of Environmental Protection, Bureau of Water & Sewer Operations, Cross-Connection Control Unit, 3rd Floor Low-Rise, 59-17 Junction Boulevard, Flushing, NY 11373.
- What to send: two original copies of the form, and two copies of all plans, engineering reports and supporting materials. Photocopies and electronic images of the form are not acceptable.
- Fee: a fee applies for each water service connection and must be attached to the form, as a check or money order payable to NYC Water Board. The form prints the current amount.
- Questions: DEP's designated representative's telephone number on the form is (718) 595-5463.
- Paper forms: to request backflow prevention forms by mail, call 311.
DEP notifies the owner by mail when plans are approved. FillingPDF lets you fill out and download the PDF; submission follows the channels above.
Common mistakes to avoid
- Leaving an item blank instead of writing N.A.; the instructions require every item from 0 through 13 to be filled, with no missing or incorrect entries.
- Submitting photocopies or electronic images of the form; the instructions require original sets and two originals must be submitted.
- Signing or stamping only one copy; the owner's original ink signature and the PE's or RA's original ink signature and seal are required on both copies.
- Writing a firm's name in item 9 instead of the name of the PE or RA who designed the plan.
- Giving a vague assembly location in item 5; DEP asks for the exact spot (for example, basement, cellar, vault) and a measured reference.
- Leaving item 12, the estimated installation cost, blank; no blank is permitted, and fair market value is used if the work is free.
- Omitting the block, lot or tentative lot numbers in items 0 to 4a; the instructions say wrong information delays approval.
- Entering an incorrect or inactive owner or design professional mailing address, which delays DEP's notification.
- Filling in item 14, which only the Department completes.
Frequently asked questions
What is Form GEN236 used for?
Form GEN236 is the NYC DEP application for approval of backflow prevention assemblies. A Professional Engineer or Registered Architect submits it with the plans so DEP's Cross-Connection Control Unit can approve them before a device is installed. Approval is valid for two years from the approval date.
Who can fill out the backflow prevention device approval form?
DEP says Professional Engineers (PE) and Registered Architects (RA) fill it out and use it to apply for approval of backflow prevention device plans. The property owner also signs in item 7, in original ink.
Can I fill out Form GEN236 online?
You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is an independent service and does not send it to DEP. You sign the printed copies in original ink and submit them through DEP's channels.
Where do I send Form GEN236?
Send it to NYC DEP, Bureau of Water & Sewer Operations, Cross-Connection Control Unit, 3rd Floor Low-Rise, 59-17 Junction Boulevard, Flushing, NY 11373. Include two original copies of the form and two copies of all plans, engineering reports and supporting materials.
Is there a fee to submit Form GEN236?
Yes. The form says a fee applies for each water service connection and must be attached as a check or money order payable to NYC Water Board. The form prints the current amount, and DEP's representative can be reached at (718) 595-5463.
Can I get the backflow forms through NYC 311?
You can call 311 to request backflow prevention forms by mail. DEP also says that if your property or business type is not on its list of required properties and you have a question about legal requirements, you can call 311 to have it directed to DEP.
Do I need Form GEN236 if I have only one domestic service line?
Not necessarily. DEP provides separate self-certification forms for PEs and RAs: one for an installation plan on a domestic service line only, and one to certify that a facility with one domestic service line needs no device. Check them before using this form.
What is the difference between this form and the backflow test form?
Form GEN236 asks DEP to approve the installation plans before the device is installed. The Backflow Prevention Device Test Form reports test results, first after installation and then every 12 months, and is completed by a certified tester.
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