RPBA FormDate:
Property Address:
Business License Applicant:
Dear Applicant:
Washington State Department of Health, in WAC 246-290-490 states that all group A water systems with 1000 or more connections are required by the Department of Health to develop and
implement a cross control connection program. This program requires all commercial buildings and irrigation systems to have a Reduced Pressure Backflow Assembly (RPBA) device installed
on the water services. A list of approved devices can be located at the above referenced Washington Administrative Code.
Installation of the RPBA device is required prior to approval of your business license.
The RPBA must be inspected by xxxx and receipt of inspection provided to Kevin Ray at the address below. If you have any questions, please contact Mr. Ray at (360) 458-8410.
Kevin Ray,
City of Yelm Public Works
105 Yelm Avenue West
Yelm, WA 98597
(360) 458-8410
kevinr@ci.yelm.wa.us