Fillable Backwater Valve Application Packet 20200602 1.sflb.ashx

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Backwater Valve Application Packet 20200602 1.sflb.ashx

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Page 1 of 9
Revised 06012020
CITY OF ALBANY BACKWATER VALVE GRANT APPLICATION PACKAGE
Pupose:
The backwater valve reimbursement program was established to provide financial assistance to homeowners who desire
to protect their home from flooding during a heavy rain event and sewer backups due to capacity of the City’s combined
sewer. Eligible homeowners may qualify for a maximum of $2,500 for installation backwater valve system which can
protect their basements from sewer back-up. Roof drain separation from the sanitary is required for the backwater valve
installation. Also internal plumbing modifications to raise the lowest “open” fixture to an elevation higher than the rim of
the upstream manhole is covered under this program.
What is Eligible?
1. Installation of a backwater valve (internal of the house or external of the house) -$2,000 maximum reimbursement.
For this option if roof drain separation is required participants are eligible up to an additional $500.
2. Plumbing modifications to raise the lowest “open” fixture to an elevation higher than the rim of the upstream
manhole- $2,000 maximum reimbursement.
Who is Eligible?
This program is available to the owner of any single family or two family dwellings, owner occupied, in the City of
Albany where a backup of combined sewage due to sewer incapacity on the municipal system occurred since 2002.
Eligible Costs:
Costs to locate, excavate, and expose house lateral sewer line and connect backwater valve and clean-out to the existing
lateral;
Costs to disconnect roof drain from sanitary sewer;
Costs to trench and repair concrete floors;
Costs to modify plumbing to raise the lowest “open” fixture to an elevation higher than the rim of the upstream manhole;
Cost of grass seeding to restore disrupted grass/lawn;
Applicable permit fees.
Non-Eligible Costs:
Removal and replacement of interior walls and finishes.
Use of materials not meeting the requirements of the City’s guide specifications or City codes.
Ancillary homeowner improvements not necessary to provide sanitary sewer back-up protection of the basement.
Planting or replacement of new landscaping (bushes, trees, sod, fences, walls, etc.)
Installing a backwater valve and cleanout when house already has an overhead sewer system.
KATHY M. SHEEHAN
C
ITY OF ALBANY
D
EPARTMENT OF WATER & WATER SUPPLY
10
NORTH ENTERPRISE DRIVE
A
LBANY, NEW YORK 12204
T
ELEPHONE (518) 434-5300
FAX (518) 434-5332
J
JOSEPH E. C OFFEY, JR , P.E.
M
AYOR COMMISSIONER
Page 2 of 9
Revised 06012020
Instructions How to Apply For the Backwater Valve Grant Program
Step 1: Contact the City of Albany Water Department at (518) 434-5300 to get a copy of the program packet or go to
the City of Albany’s website and download the packet.
Step 2: Complete the application and the Homeowners Participation Agreement
Step 3: Call plumbers and/or contractors and get two (2) written detailed cost estimates for the work to be performed. If
the estimate is for a backwater valve the estimate needs to include the make and model number of the backwater
valve. Applicant will obtain a work order and estimate from two (2) contractors (either a licensed plumber or a
site work contractor) which will define the scope of the work, provide specifications for the work to be performed
together with specific materials. The estimate must include all costs associated with the work. This must be
submitted to the Department of Water & Water Supply (AWD) as an attachment to the grant application. If the
work order and estimate is unacceptable to the AWD, the reason for denial will be indicated and the Applicant
will have the opportunity to resubmit this portion of the application within thirty (30) days of the receipt of the
denial.
Step 4: Submit completed permit application with two (2) cost estimates by mail, fax or email with required
documentation to:
Backwater Valve Grant Application Program
City of Albany Department of Water & Water Supply
10 North Enterprise Drive
Albany, NY 12204
Fax 518-434-5332
Email:lmerwin@albanyny.gov
It is recommended the applicant make copies of any papers, photos, the two (2) itemized cost estimates including scope
of work, make and model of backwater valve, etc. submitted and retain a copy for their records.
Step 5: After receipt of a properly completed application, the dwelling must be inspected by a City official or a City
appointed inspector who must certify that the dwelling is eligible based upon the history of incidents. The City
official or a City appointed inspector will also verify whether roof drainage or sump pumps are connected to the
lateral and will recommend additional steps which may be necessary for an effective installation of a backwater
valve.
Step 6: A written approval including a notice of the grant amount will be issued by the AWD. When the written
notification of the grant is received, the Applicant may enter into a contract with the approved contractor. The
Applicant will have a maximum of six (6) months after receipt of the written approval of the grant to complete
the installation as defined in the work order and estimate. Requests for additional time to complete the installation
must be made in writing and must be received at least thirty (30) days prior to the expiration of the six (6) month
period. In the event that a grant award expires, an Applicant will be required to resubmit the grant application.
Step 7: Once work is completed, the Applicant must contact the AWD to request an inspection. An inspection will be
conducted by the AWD and a written notice of acceptance issued. In the event that there are deficiencies, the
AWD will indicate what deficiencies have been noted and the Applicant will be allowed to correct these
deficiencies within thirty (30) days of the inspection. When inspection has been satisfactorily completed, the
AWD will authorize payment be issued to the Applicant.
Step 8: After the work has been inspected and approved, the homeowner needs to pay the full amount to the
plumber/contractor and then needs to submit the following:
Complete Voucher Form for reimbursement
A copy of a paid and itemized invoice from the plumber/contractor who did the work
A copy of the cancelled check (both sides) that the homeowner paid for the work
Submit to the City of Albany Water Department for processing
A check will be mailed to the Applicant after all the required paperwork is submitted.
Page 3 of 9
Revised 06012020
REQUIREMENTS FOR AN ACCEPTABLE
BACKWATER VALVE INSTALLATION
Re: Backwater Valve Installations under Grant Program
The City of Albany Department of Water & Water Supply has set the goal for all installations to have a functional and maintainable
backwater valve installed on all Applicants’ dwellings. Float valves in floor drains do not comply. The following applies to all
installations seeking approval under the Backwater Grant Program:
For exterior installation, valve must be accessible for periodic maintenance and cleaning. Extendable PVC backwater
valves are acceptable. If any other method is to be used, the valve installer must submit details for approval with his/her
estimate. The installer should demonstrate to the Applicant how to remove the extendable section, if an extendable valve
is utilized. Installer should also demonstrate how to reset it and secure the valve in place.
For interior installation, the backwater valve must be placed between the house trap and the outside sewer lateral. No other
openings (i.e., pit drains, floor drains, etc.) may remain open between the backwater valve and the outside sewer lateral.
This may require excavating the existing house trap and moving its location further from the foundation wall. Backwater
valves must be accessible and clear of any concrete or other materials which inhibit the opening of the valve for periodic
maintenance and cleaning. A CITY OF ALBANY LICENSE PLUMBER NEEDS TO BE HIRED FOR INTERIOR
INSTALLATION AND A PLUMBING PERMIT IS REQUIRED IN ADDITION TO THE DEPARTMENT OF
WATER’S WATER AND SEWER PERMIT.
Due to failures which have taken place with PVC backwater valves installed inside dwellings, these occur where the PVC flap sits
on a hanger and can come off during flows especially under higher pressures, backwater valves with the type where the flap is
pinned so it is not susceptible to this type of failure are required for the Backwater Grant Program. Acceptable Backwater valves
are:
1. Globe Manufacturing Model 2604 4” no hub backflow valve (or Model 2606 for 6” pipes)
2. Jay R. Smith Model 7012S-04 for 4” or 7012S-06 for 6” pipe
3. Wade – Model 4204NH
4. Josam – No Hub Model 67400
If you want to use another manufacturer, please submit a cut sheet prior to installing.
Both type of valves should be periodically inspected and cleaned when necessary. Valve manufacturers provide information
regarding this process. A copy of this information should be provided to the applicant.
Also note that all installers must obtain a permit from the City of Albany Department of Water & Water Supply. You must
also call during normal business hours to contact the Department’s dispatch office at (518) 434-5322 to arrange for the inspection
twenty-four (24) hours before the area is excavated to install the valve. Pipes and backwater valve shall be visible and in place
for inspection.
Page 4 of 9
Revised 06012020
BACKWATER VALVE GRANT APPLICATION CHECKLIST
The following checklist has been made available to ensure that applications submitted to the Albany Water
Department are reviewed and processed in a timely manner. If the submitted application does not include the
required information, the application will not be approved.
☐ Backwater Valve Application Completely Filled Out
Backwater Valve Grant Application (pages 5 & 6)
☐ Items 1-13 completely filled out
☐ Item 11A: Proof provided and attached
☐ Item 11B: Dates of calls made to Albany Water Department
Backwater Valve Grant Application (page 6)
☐ Item 12a Complete Name of Contractor/Plumber Want to Use
☐ Items 12b-e completed
☐ Describe Scope of Work (Diameter, Material, Length, etc.)
☐ Verification Page (page 7)
☐ Signed and notarized by all homeowners of the property
☐ Two Itemized Cost Estimates from Contractor/Plumber stating model of backwater valve
1. Cost Estimate from ______________________________ Amount____________________
☐ Describe Type of Work (Diameter, Material, Length, etc.)
2. Cost Estimate From ______________________________Amount____________________
☐ Describe Type of Work (Diameter, Material, Length, etc.)
☐ Homeowner Participation Agreement (page 8)
BWG No. ____________
KATHY M. SHEEHAN
CITY OF ALBANY
DEPARTMENT OF WATER & WATER SUPPLY
10 NORTH ENTERPRISE DRIVE
ALBANY, NEW YORK 12204
TELEPHONE (518) 434-5300
FAX (518) 434-5332
J JOSEPH E. COFFEY, JR, P.E.
MAYOR
COM MISSIONER
Page 5 of 9
Revised 06012020
CITY OF ALBANY BACKWATER VALVE INSTALLATION GRANT APPLICATION
1) Property Address ________ ________________________________________________________________
(No) (Street)
2) Owner____________________________________ Second Owner___________________________________
(Last Name, First Name, M.I.) (Must be listed if dwelling is jointly owned)
3) Mailing Address ____________________________ City ______________ State _____ Zip Code ________
4) Phone No. (Home) _____________ (Work) ____________ (Cell) _____________ Best Time to Call _______
5) Year Property Purchased __________ Date you moved into home Month____________ Year_________
Property Type: Sing
le Family Two Family Other _________________________
I
s property owner occupied" Yes  No
6)
Number of Years of Residence at this Dwelling _______
7) Are your downspouts connected to the City’s sanitary sewer system? Yes No NA
8) Does your home have exterior foundation perimeter drain title? Yes No
9) Does your home have a sump pump? Yes No
If yes, does your SUMP PUMP discharge to Front, Rear, Side, to the Storm Sewer in the street?
FRONT
REAR SIDE STORM SEWER CONNECTION
10)
Does your
house presently have an overhead sewer system? Yes No
11) How many basement water events have you experienced (Num
ber of Combined Sewage Backups) since 2002" _______________
11a)
Proof Provided (Check Information and ENCLOSE COPIES) 
Insurance Claim  Photos

Statement Provided at Purchase Inspection Report Home Inspection Report 1one (&RPSOHWH3DUWE)
1
1b) No Proof Provided (&RPSOHWHRQO\LIDQVZHUWRaLV1RQH)
Did you call in a complaint to City of Albany? (Check one) Yes  No 'on’t recall
BWG No. ____________
KATHY M. SHEEHAN
C
ITY OF ALBANY
D
EPARTMENT OF WATER & WATER SUPPLY
10
NORTH ENTERPRISE DRIVE
A
LBANY, NEW YORK 12204
T
ELEPHONE (518) 434-5300
FAX (518) 434-5332
JOSEPH E. C OFFEY, JR , P.E.
M
AYOR COMMISSIONER
Page 6 of 9
Revised 06012020
Approximate date(s) when call(s) was (were) made _________ _________ __________ _______
Was your house inspected by City employee or an agent for any of these storms?
Yes (Complete Below)  (No, continue with Question No. )
Date of Storm after which inspection occurred ___________________________________
Name of Inspector (if known) _________________________________________________
* TWO (2) COST ESTIMATES MUST BE ATTACHED TO THIS FORM *
Name of Contractor or Plumber you wish to hire:
12) Information on Estimate and Scope of Services
12a) Contractor’s or Plumber Name __________________________________________________________
12b) Contractor’s or Plumber Address _________________________________________________________
(No.) (Street) (City) (State) (Zip Code)
12c) Contractor’s or Plumber Phone _______________________________Fax________________________
12d) Contractor’s Total Cost Estimate __________________________________________________________
12e) Scope of Work (Check all that apply)
Backwater Valve Installation inside dwelling 
Backwater Valve Installation outside dwelling
Sump Pump Disconnect from sanitary sewer Roof drains disconnect from sanitary sewer
Floor drain / inside pumping modifications Repair or replacement of water service
 Repair or replacement of sewer lateral beyond valve 
Repair or replacement of sidewalk or driveway 
Lawn restoration
13)
Have you applied for grant before? No Yes
If yes, were you approved? No 
Yes, but ____________________________
Do Not C
omplete Information below This Line
for Department of Water & Water Supply Use
Tax Map Parcel No. ____________________ Owner’s names verified ____ Proof of Backup Approved ____________________
Application Complete ______________ Application Incomplete ____________ Application Rejected ______________________
Reason for Rejection of Application ____________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Inspection Scheduled _____ Date ______ Time ______Phone Contact _______ Mailed Notice _____________________________
Inspector ___________________________________________ (Printed name) Initial when completed ___________________
Inspection Notes ___________________________________________________________________________________________
Page 7 of 9
Revised 06012020
BACKWATER VALVE APPLIATION VERIFICATION PAGE
(If joint ownership, verification is required for both owners)
FIRST HOME OWNER
STATE OF _________ )
) SS.:
COUNTY OF _______ )
I, ________________________________, resides at __________________________________ deposes and says that he/she has
read the foregoing application and knows the contents thereof; and that the same is true and complete and accurate to the best of
his/her knowledge.
Signature of Home Owner
Sworn to before me this day of , ________________20_.
______________________________
(Notary Public)
Qualified in __________ County
My Commission Expires ____________
SECOND HOME OWNER
STATE OF _________ )
) SS.:
COUNTY OF _______ )
I, ____________________________, resides at________________________________________deposes and says that he/she
has read the foregoing application and knows the contents thereof; and that the same is true and complete and accurate to the
best of his/her knowledge.
Signature of Home Owner
Sworn to before me this day of , ________________20_.
______________________________
(Notary Public)
Qualified in __________ County
My Commission Expires ____________
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Page 8 of 9
Revised 06012020
CITY OF ALBANY BACKWATER VALVE HOMEOWNER PARTICIPATION AGREEMENT
1. I UNDERSTAND AND AGREE that the City of Albany established the Backwater Valve program to assist residents in
protecting their home from flooding due to sewer backups. The program provides for reimbursement of eligible costs up
to a maxim of $2,500.00.
2. Prior to the installation of any plumbing work, the proposal shall be submitted to the City for review and approval. No
work shall commence until City approval is obtained and a permit is issued.
3. Reimbursement of eligible items at approved amounts will be made after the work is completed, inspected and approved
by the City. A voucher (“Request of Disbursement”) form must be completed and submitted with other documentation,
such as the detailed invoice and a copy of the cancelled check (both sides) which proves that the project was paid for, in
full, by the homeowner.
4. Liability - The City shall have no liability for any defective work or damage, injury and/or loss on account of any act or
omission of the contractor in the performance of the work. The homeowner shall make any claim for such matters directly
against the contractor or constrictor’s insurance carrier. The homeowner hereby agrees to indemnify and hold the City
harmless against any and all claims and further covenants not to sue the City for any and all claims, as no system is
absolutely fail safe.
5. Disclaimer – The Program is designed to substantially reduce the risk of basement backups. However, there is always
some risk of basement backup as a result of unexpected sewer collapse, obstruction, power failure, extreme environmental
conditions or other unforeseen factors. Proper operation of foundation drains is necessary to prevent seepage of ground
water through walls below grade. Existing foundation drains are necessary to prevent seepage of ground water through
walls below grade. (The homeowner is reminded that footing drains, storm water tiles and all perimeter drains must be
disconnected from the sanitary system.) Storm water/ground water discharges shall be disposed of properly.)
6. Proper Maintenance and Inspection
The homeowner is responsible for preventative maintenance including regular inspection to ensure proper operation. The
Homeowner shall have the responsibility to conduct required maintenance. The backwater valve should be inspected every
three (3) to six (6) months to ensure that the device is operating properly, especially before the spring thaw; debris can
build up behind the flapper. The plumber/contractor should provide the homeowner with the manufacturer’s
recommendation of maintenance requirements.
I understand and agree with all of the above statements and agree to comply accordingly.
________________________________________________________________________________________________
First Homeowner – Printed Name Signature Date
________________________________________________________________________________________________
Second Homeowner – Printed Name Signature Date
Property Address________________________________________________________________________________
BWG No. ____________
KATHY M. SHEEHAN
C
ITY OF ALBANY
D
EPARTMENT OF WATER & WATER SUPPLY
10
NORTH ENTERPRISE DRIVE
A
LBANY, NEW YORK 12204
T
ELEPHONE (518) 434-5300
FAX (518) 434-5332
J
JOSEPH E. C OFFEY, JR , P.E.
M
AYOR COMMISSIONER
Page 9 of 9
Revised 06012020
BACKWATER VALVE GRANT CONTRACTOR/PLUMBER LIST
This is a list of contractors/plumbers who have installed backwater valves outside or inside of dwellings under the
current Backwater Valve Grant program in the past four (4) years. This list is arranged alphabetically. This is intended
to assist applicants in choosing a contractor/plumber. Please do not limit your search to this list only. All
contractors/plumbers should be made aware of the “REQUIREMENTS FOR AN ACCEPTABLE BACKWATER
VALVE INSTALLATION,” which are available from the Department of Water & Water Supply.
The backwater valve may be installed by any plumber registered with the City of Albany Division of Building and
Codes for inside installations. Plumbing Permit is required in addition to Water Sewer Permit.
Two (2) cost estimates are required with the make and model number of the valve the contractor/plumber is proposing
to install.
Apex Plumbing & Drain 872 Albany Shaker Road, Latham, NY 12110 Phone: 518-785-0795
Burnett Excavating 82 Beverly Ave, Albany, NY 12209 Phone: 518-462-0480
C.A. Trichilo 161 Helderberg Trail, East Berne, NY 12059 Phone: 518-857-2156
Crisafulli Brothers 520 Livingston Ave, Albany, NY 12206 Phone: 518-449-1782
Farrell Bros. Inc. 6 Simmons Lane, Albany, NY 12204 Phone: 518-462-5454
Keith Lezatte 56 Plank Road, Feura Bush, NY 12067 Phone: 518-378-5900
Metro Plumbing Paul Bishop PO BOX 376, Watervliet, NY 12189 Phone: 518-785-0576
Precision Plumbing Sean Clark 26 Tice Road, Albany NY 12203 Phone: 518-464-0090
Taub Heating & Plumbing Paul Karin Jr. 386 Elk Street, Albany NY 12206 Phone: 518-463-8885
KATHY M. SHEEHAN
C
ITY OF ALBANY
D
EPARTMENT OF WATER & WATER SUPPLY
10
NORTH ENTERPRISE DRIVE
A
LBANY, NEW YORK 12204
T
ELEPHONE (518) 434-5300
FAX (518) 434-5332
J
JOSEPH E. C OFFEY, JR , P.E.
M
AYOR COMMISSIONER
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