36E77619R0042-004.pdf

Water & Sewer Demand Study

VA Northern California Healthcare

System (VANCHCS)

Updated Final Report

VA Project Number: 612A4-17-109

January 2019

This Page Intentionally Left Blank

For Double-Sided Printing

TABLE OF CONTENTS

EXECUTIVE SUMMARY

WATER

SEWER

DESIGN CRITERIA

APPLICABLE INDUSTRY CRITERIA

PRECEDENCE

DESIGN REQUIREMENTS

OVERVIEW

SITE DEVELOPMENT

SITE PHYSICAL SECURITY

FEDERAL AVIATION ADMINISTRATION (FAA)

WATER LINE UPGRADE

SITE UTILITIES

OVERVIEW

WATER DEMAND ANALYSIS

EMERGENCY WATER SUPPLY

SCHEMATIC DESIGN

IRRIGATION

SANITARY SEWER

STORM SEWER

UTILITY MONITORING

METERING FOR USE

COMPONENTS OF HEALTHCARE-ASSOCIATED (HCA) LEGIONELLA DISEASE (LD)

CONTROL STRATEGIES FOR ONGOING PREVENTION OF LEGIONELLA GROWTH

SUPPLEMENTAL ACTIONS

EMERGENCY REMEDIATION OF THE POTABLE WATER DISTRIBUTION SYSTEMS

SPECIAL USE WATER SYSTEMS

PLUMBING

SEISMIC REQUIREMENTS

HISTORICAL WATER DATA

EXISTING POTABLE WATER ISOLATION VALVES

EXISTING BUILDINGS

FIRE PROTECTION

FIRE SYSTEM DEMAND

APPENDIX A: SURVEY INFORMATION- ELEMENT ENGINEERING ................................................. A1

APPENDIX B: AES DRAWINGS ....................................................................................................... B1

APPENDIX C: ALTERNATE TANK INFORMATION ........................................................................... C1

APPENDIX D: SEISMIC MAP .......................................................................................................... D1

APPENDIX E: UPDATED COST ESTIMATE ...................................................................................... E1

APPENDIX F: VHA DIRECTIVE 1061 ............................................................................................... F1

APPENDIX G: MATHER VA PLANNED PROJECTS ........................................................................... G1

WATER & SEWER STUDY SD REPORT

VANCHCS January 2019

PART A – GENERAL DESCRIPTION

EXECUTIVE SUMMARY

AES was hired by VA Northern California Health Care Systems (to be referred to as VANCHCS) to conduct a study on how to provide an efficient water supply and sanitation system for the current and future expansion at the Mather campus.

The Scope of Work received from VANCHCS stated that the Mather campus covered an area of 410,000 square feet and housed a total of 30 buildings that includes the existing Sacramento Medical Center (Building 700) and the New Hospital Building (Building 650). However once AES conducted a survey of the campus, it was discovered that the campus actually covers an area of 1,300,000 square feet and houses a total of 35 buildings. The prominent buildings on the campus are the existing Sacramento Medical Center (Building 700), located slightly to the west of the center of campus, and the New Hospital Building (Building 650), located to the west of the campus.

Fig-1: Mather VA Campus Existing & Proposed Water Supply Loops

WATER

Per the SOW, currently the entire campus is being serviced by three-8 inch waterlines coming from the south part of the campus along Peter McCuen Blvd as shown above.

These lines are reduced to 6 inches inside the campus and form a loop around the campus as shown. Each of the buildings are connected to the main loop by smaller lines, ranging from 3/4 inch to 6 inches. There is also a 40,000 gallon above ground emergency water storage tank that is connected to the loop. Additionally, the Fire Protection system (Fire Hydrants) is also tied into the main loop.

SEWER

The campus has four lift stations, one along Peter McCuen Blvd and the other three across the back of the campus. The campus sewer system distributions are serviced by 8 inch lines that are about 10 feet deep.

The primary purpose of the study is to provide a plan to improve the distribution of water flow, volume, pressure, and service reliability to the current buildings and future buildings.

The VA has requested the following:

1. That the preliminary engineering design (schematic) of the water supply and sewer distribution system be carried out to a degree of detail that will enable estimates of the quantities and cost of the project component to be made within 10% of the final as-built value.

2. That AES shall determine the existing demand for water and sewer and projected demand over a 15 year period by determining patients and employee population growth rate.

3. The existing and projected water demand shall be categorized into domestic, irrigation uses, as well as wastewater.

4. The demand shall also be broken down by the building, Average Daily Demand, Maximum Daily Demand, and Peak-Hour Demand shall be determined and projected.

5. Provide at least two alternatives and presented to VA with cost estimate for each scheme including the recommendation.

DESIGN CRITERIA

Applicable design and construction criteria references are listed below. Criteria shall be taken from the most current references as of the date of issue of the construction contract. This list is not intended to include all criteria that may apply or to restrict design and construction to only those references listed. Some of the listed standards do not apply in their entirety; only selected provisions of some documents and standards apply as referenced. The designer is to use the most current codes available at the time unless otherwise noted in the contract.

References are as follows:

APPLICABLE INDUSTRY CRITERIA

AMERICAN SOCIETY OF MECHANICAL ENGINEERS (ASME):

B31 - Code for Pressure Piping Standards

AMERICAN SOCIETY FOR TESTING AND MATERIALS (ASTM):

C651-05 - Disinfecting Water Mains

C858-10e1 - Underground Precast Utility Structures

D1785-06 - Poly Vinyl Chloride (PVC) Plastic Pipe, Schedules 40, 80, and 120

D2464-06 - Threaded Poly Vinyl Chloride PVC Pipe Fittings, Schedule 80

D2466-06 - Poly Vinyl Chloride (PVC) Pipe Fittings, Schedule 40

D2467-06 - Poly Vinyl Chloride (PVC) Plastic Pipe Fittings, Schedule 80

AMERICAN WATER WORKS ASSOCIATIION (AWWA):

C104-08 - Cement-Mortar Lining for Ductile-Iron Pipe and Fittings for Water

C105-10 - Polyethylene Encasement for Ductile-Iron Pipe Systems

C110-12 - Ductile Iron & Gray-Iron Fittings

C111-17 - Rubber-Gasket Joints for Ductile-Iron Pressure Pipe and Fittings

C116-15 - Protective Fusion-Bonded Epoxy Coatings for the Interior and Exterior Surfaces of Ductile-Iron and Gray-Iron Fittings

C150-14 - Thickness Design of Ductile-Iron Pipe

C151-17 - Ductile-Iron Pipe, Centrifugally Cast

C153-11 - Ductile-Iron Compact Fittings for Water Service

C200-17 - Steel Water Pipe-6 in (150 mm) and Larger

C205-12 - Cement-Mortar Protective Lining and Coating for Steel Water Pipe-4 in (100 mm) and Larger-Shop Applied

C206-17 - Field Welding of Steel Water Pipe

C207-13 - Steel Pipe Flanges for Waterworks Service--Sizes 4 in Through 144 in (100 mm through 3600 mm)

C208-17 - Dimensions for Fabricated Steel Water Pipe Fittings

C209-13 - Cold-Applied Tape Coatings for the Exterior of Special Sections, Connections, and Fittings for Steel Water Pipelines

C210-15 - Liquid-Epoxy Coatings and Linings for Steel Water Pipe and Fittings

C213-15 - Fusion-Bonded Epoxy Coatings and Linings For Steel Water Pipe and Fittings

C214-14 - Tape Coatings for Steel Water Pipe

C215-16 - Extruded Polyolefin Coatings for the Exterior of Steel Water Pipelines

C216-15 - Heat-Shrinkable Cross-Linked Polyolefin Coatings for Steel Water Pipe and Fittings

C217-16 - Microcrystalline Wax and Petrolatum Tape Coating Systems for Steel Water Pipe and Fittings

C218-16 - Liquid Coating for Aboveground Steel Water Pipelines and Fittings

C219-17 - Bolted, Sleeve-Type Couplings for Plain-End Pipe

C220-17 - Stainless-Steel Pipe, 1/2 in (13 mm) and Larger

C221-12 - Fabricated Steel Mechanical Slip-Type Expansion Joints

C222-08 - Polyurethane Coatings for the Interior and Exterior of Steel Water Pipe and Fittings

C223-13 - Fabricated Steel and Stainless Steel Tapping Sleeves

C227-17 - Bolted, Split-Sleeve Couplings

C229-15 - Fusion-Bonded Polyethylene Coatings for Steel Water Pipe and Fittings

C231-17 - Field Welding of Stainless Steel Water Pipe

C500-09 - Metal-Seated Gate Valves for Water Supply Service

C504-15 - Rubber-Seated Butterfly Valves

C507-15 - Valves, 6 in Through 60 in (150 mm Through 1,500 mm)

C508-17 - Swing-Check Valves for Waterworks Service, 2-in Through 24-in (50mm Through 600-

mm) NPS

C509-15 - Resilient-Seated Gate Valves for Water Supply Service

C510-17 - Double Check Valve Backflow Prevention Assembly

C511-17 - Reduced-Pressure Principle Backflow Prevention Assembly

C512-15 - Air-Release, Air/Vacuum, and Combination Air Valves for Water and Wastewater Service

C514-15 - Air Valve and Vent Inflow Preventer Assemblies for Potable Water Distribution System and Storage Facilities

C515-15 - Reduced-Wall, Resilient-Seated Gate Valves for Water Supply Service

C530-17 - Pilot-Operated Control Valves

C550-17 - Protective Interior Coatings for Valves and Hydrants

C600-17 - Installation of Ductile-Iron Water Mains and Their Appurtenances

C605-13 - Underground Installation of Polyvinyl Chloride (PVC) Pressure Pipe and Fittings for Water

C606-15 - Grooved and Shouldered Joints

C651-14 - Disinfecting Water Mains

C652-11 - Disinfection of Water-Storage Facilities

C653-13 - Disinfection of Water Treatment Plants

C700-15 - Cold-Water Meters - Displacement Type, Bronze Main Case

C701-15 - Cold-Water Meters - Turbine Type, for Customer Service

C702-15 - Cold-Water Meters - Compound Type

C703-15 - Cold-Water Meters - Fire-Service Type

C704-15 - Propeller-Type Meters for Waterworks Applications

C707-10 - Encoder-Type Remote Registration Systems for Cold-Water Meters

C708-15 - Cold-Water Meters - Multijet Type

C710-15 - Cold-Water Meters - Displacement Type, Plastic Main Case

C800-14 - Underground Service Line Valves and Fittings

C900-16 - Polyvinyl Chloride (PVC) Pressure Pipe and Fabricated Fittings, 4 in -

60 in (100 mm - 1,500 mm)

C907-17 - Injection-Molded Polyvinyl Chloride (PVC) Pressure Fittings, 4 in Through 12 in (100 mm Through 300 mm), for Water, Wastewater, and Reclaimed Water Services

D100-11 - Welded Carbon Steel Tanks for Water Storage

D102-17 - Coating Steel Water-Storage Tanks

D103-09 - Factory-Coated Bolted Steel Tanks for Water Storage & Addendum

D104-17 - Automatically Controlled, Impressed-Current Cathodic Protection for the Interior Submerged Surfaces of Steel Water Storage

D106-16 - Sacrificial Anode Cathodic Protection Systems for the Interior Submerged Surfaces of Steel Water Storage Tanks

D130-11 - Geomembrane Materials for Potable Water Applications

F110-16 - Ultraviolet Disinfection Systems for Drinking Water

G100-17 - Water Treatment Plant Operation and Management

G200-15 - Distribution Systems Operation and Management

G300-14 - Source Water Protection

G400-09 - Utility Management System

G440-17 - Emergency Preparedness Practices

G480-13 - Water Conservation Program Operation and Management

M23-2nd Ed. - PVC Pipe, Design and Installation

VA DESIGN CRITERIA

PG 18-1 - Master Construction Specifications

PG 18-3 - Design and Construction Procedures

PG 18-4 - National CAD Standard Details

PG 18-5 - Equipment Guide List

PG 18-10 - Design Manuals (By Discipline)

Estimating, March 2011

Fire Protection, December 2015

Plumbing Design Manual, November 2014

PG 18-15 - A/E Design Submission Requirements

Volume C - Minor and NRM Projects, November 2008

PRECEDENCE

In the event of conflict between References and/or other Applicable Criteria, the most stringent requirement will apply, unless otherwise specifically noted in the contract. Where there is a conflict between a general requirement and a specific requirement, the specific requirement will apply.

Throughout this document, the use of the code acronym and number (if applicable) will be used to reference the above list of codes/standards and associated edition (e.g., NFPA 13, NFPA 72, IBC, etc.)

PART B – DESIGN REQUIREMENTS

DESIGN REQUIREMENTS

OVERVIEW

The purpose of this water and sewer demand study is to provide a sufficient water supply and sanitation system for the current and future expansion at the Mather VA campus. The Mather VA is a 35 building campus covering approximately 1,300,000 square feet. The VA has raised concern over water pressure issues and the need for an emergency water storage supply. It has been determined that upsizing the existing 6-inch water loop to 8-inch and implementing an elevated water tank will solve pressure issues and hold a 96-hour emergency water supply. The existing system and schematic designs showing two options have been provided in Appendix B. There are many considerations to incorporate a water tower into an existing campus. The considerations, background, and calculations for this design are provided in the following sections.

SITE DEVELOPMENT

The water tower and pump house requires a total area of 0.53 acres. AES conducted a site walkthrough to provide an adequate understanding of the existing site.

The location of the water tower was arrived at, after considering several factors such as existing site constraints, future projects planned (Appendix G), and standoff distance guidelines. Initially 2 options were presented to the VA- one was to have the water tower in the gravel lot next to the plumbing office and the other in the lot north of the gravel lot which the VA was in the process of purchasing at the time. Both locations worked in terms of ease of tie- in to the existing water system. While the first option would have minimized the amount of piping required for the project, it would reduce the number of parking spots in the campus. The present decision to have the tank located on newly acquired land was mutually agreed on by AES and VA. The major advantage of this location is that is avoids future construction as maintains functionality of the gravel lot adjacent to the plumbing office.

The water tower will be connected by a 6-inch fill line from the 8-inch source at the southeast of campus and also connected by an 8- inch supply line to the loop north of campus.

SITE PHYSICAL SECURITY

A standoff distance of 50 feet is required for any mission critical facility. Fencing for force protection is required as the project is a utilities extension. It is suggested to provide 8 foot high, anti-climb, high-grade metal fencing in accordance with the Mission Critical Physical Design Manual for VA Facilities.

Parking is not allowed within 50 feet of any mission critical facility; therefore it is recommended to place the pump house on the opposite side of the tower from any parking spaces to reduce the footprint and cost of each option. The recommended layout is provided in Appendix B, PP100.

FEDERAL AVIATION ADMINISTRATION (FAA)

FAA clearance guidelines must be met due to the Mather campus being adjacent to an active airfield. The water tower location falls into zone B Horizontal Surface and would be limited to 150 foot height according to Federal Aviation Regulation 77.25 (see image below). A waiver will be required for either option.

A UTILITY RUNWAYS

B RUNWAYS LARGER

THAN UTILITY

C VISIBILITY MINIMUMS

GREATER THAN 3/4

D

VISIBILITY MINIMUMS

AS LOW AS 3/4 MILE

PRECISION INSTRUMENT

APPROACH SLOPE IS 50:1

FOR INNER 10,000 FEET

AND 40:1 FOR AN

ADDITIONAL 40,000 FEET

Fig-2: Civil Airport Imaginary Surfaces & Obstruction Identification

Source: https://www.ngs.noaa.gov/AERO/oisspec.html

WATER LINE UPGRADE

Proper phasing of construction activities is vital to avoid, to the extent possible, disruption of VA services. AES currently sees site and building construction activities proceeding along the following sequence:

• Construction in the parking areas will be phased to allow traffic access to all parking spaces not directly affected by construction. Trenching, laying pipe, and paving will be sectioned to block half or less of the parking.

• Road cuts crossing the roadway will be coordinated with VA officials to minimize traffic flow issues.

All trenched locations will be paved immediately following utility construction. This is to provide an immediate finished product and to avoid traffic, storm water, or other potential conflicts.

Proper erosion and sediment controls must be included in each phase of construction.

https://www.ngs.noaa.gov/AERO/oisspec.html

SITE UTILITIES

OVERVIEW

A utility survey was conducted by Element Engineering (Appendix A). The existing water and sewer systems are shown on the VU series drawings in Appendix B. Water and sewer system analyses and recommendations are provided in the following sections of the report.

WATER DEMAND ANALYSIS

An analysis of the total water demand for the Mather VA campus has been conducted to verify if the existing system is adequate for present day and future use. The water demand is calculated based on the usage data provided by the VA. A breakdown of the average water use for 2016 and 2017 is provided in the table below.

Instantaneous water demand is based on the number of Water Supply Fixture Units (WSFUs) listed in the International Plumbing Code Table 103.3(2). The campus building total is 4,066 WSFUs, equating to approximately 530 gpm (Table E103.3(3) ). The concern with pipe sizing is water velocity in the pipe leading to erosion and pressure drop from high water velocity. The VA design guide provides a maximum allowable velocity of 8 ft/sec. The current campus loop is mostly 6 in ductile iron which with the flow of 530 gpm has a velocity of 6 ft/sec but a pressure drop of approximately 1.6 psi/100 ft when new. It is likely that the pipe is more like the fully rough chart (Figure E103.3(7) ) which shows a pressure drop of approximately 2.5 psi/100 ft. This pressure drop becomes significant over the extent of the campus loop. The numbers listed do not include irrigation water due to lack of information about watering schedules and also possible fire suppression flow. It is our recommendation to replace the campus loop with 8 in PVC to add capacity, lower water velocity and pressure drop to approximately 0.3 psi/100 ft. The existing loop is functional but not ideal in its current condition and a contributor to the overall pressure problems due to the high pressure drop.

A simple pressure loss through a pipe calculation was then used to calculate the pressure loss between the outlet of the water tower to the furthest fixture served. The following pressure loss calculation was performed using the following equation and inputs and the variables were converted to SI units.

The pipe length used is the length from the outlet of the water tower to the furthest fixture in the new loop which was approximately 2765 feet. Assumptions were made for the number of valves and elbows in the new loop based off of the current design and survey information. The appropriate roughness factor was then applied and the GPM was increased by approximately 12.5% to 600 GPM for future demand. Using the above calculation, the approximate pressure loss from the tower to the furthest fixture was approximately 12 psi. The pressure loss to the furthest building was then added to the desired psi of the furthest building (75 psi), resulting in 87 psi. The minimum water level in the tower must produce 87 psi at the tower outlet in order to provide the desired psi of 75 at the furthest node. The minimum water level pressure was then converted to feet of head.

Thus, the minimum water level in the tower must be at a height of approximately 201 feet above the finished grade in order for the furthest fixture to reach the desired pressure of 75 psi.

Values provided above are for the entire campus and represent potable, fire, and irrigation usage.

Irrigation usage is variable and is taken into account to determine the needed average potable water demand. A few assumptions are made to determine the overall average daily water demand. A conservative approach to all assumptions is used to maintain adequacy of this study and schematic design. Our first assumption is that irrigation use is variable, but a maximum demand can be determined by the September average. The next assumption is that 0 gallons are used for irrigation from January to March. Based on meter data from the VA, we also assume an approximate value of 29,000 gallons per day (GPD) are used per week for the main buildings on campus. The rest of the campus is estimated to be an additional 16,000 GPD.

Based on these assumptions, the average daily use without irrigation is approximately 45,000 gallons and the maximum daily use with irrigation is approximately 92,000 gallons.

[(Average Daily Demand X 4) + (180,000 Fire Storage) + (Maximum Daily Use)] X 1.25 = Total Volume

EMERGENCY WATER SUPPLY

The existing emergency water supply for the Mather VA campus is inadequate. The existing 40,000 gallon tank only supplies demand needed at peak times during the day and refills approximately every 4 to 6 hours. A 96-hour emergency supply system that includes fire water and required daily demand needs to be implemented into the system. The 96-hour emergency supply volume has been determined according to the average daily demand without irrigation and required fire water demand. Maximum daily water use is incorporated into the water tower volume as operational storage. The recommended operational storage amount in the water tower is capable of replacing the existing 40,000 gallon tank.

The average daily demand without irrigation is determined to be 45,000 GPD per the water usage information provided by the VA for 2016 and 2017. The minimum emergency fire water allowed is 180,000 gallons per the VA Physical Security Design Manual. The maximum daily use with irrigation is 92,000 gallons. The total 96-hour emergency water supply with a safety factor of 1.25 incorporated is determined to be 565,000 gallons. The factor of safety is used to account for unexpected rises in daily demand during the 96-hour period. A 565,000 gallon tank is adequate for the emergency water storage.

SCHEMATIC DESIGN

The schematic design is provided to recommend changes to the existing water system to resolve pressure issues and incorporate an emergency supply system. The existing domestic water system loop mains need to be upsized and an emergency water source (water tower) will need to be added. The new 8 inch diameter domestic water main loop will be installed in approximately the same location as the existing loop but installed in a manner which will minimize the disruptions of daily campus activities for staff and patients due to construction. The new loop will be tied into the three existing 8 inch diameter domestic water intake lines coming from the city water supply along the south side of the campus. The new water tower will be located in the northeast corner of the campus and will serve as an additional potable water source for the campus. The 6 inch diameter domestic water fill line serving the water tower will be tapped off of the 8 inch diameter existing intake lines at the approximate “corner” of the main loop, just west of Building 707 and will be routed south along the west sides of buildings T-7 and

801. It will then turn east and run along the south boundary of the campus until it turns north towards the water tower. Refer to sheet PP100 in Appendix B for routing and sheet PP101 for the water tower and pump house plumbing schematic.

PRESSURE SOLUTION

The campus has expressed concerns with the domestic water system, specifically pressure inconsistencies due to the age of the system and ultimately due to the system being undersized for its current usage. Many of the buildings have had issues with pressure, specifically Building 645 which required the installation of a booster pump to help mitigate a low pressure issue. This analysis has determined the need to upsize the existing 6-inch loop system to 8-inch. This is due to the flow rates required at any point in the loop if a portion of the system fails and is closed off. A total of 2,000 gallons per minute (GPM) are available with the three 8-inch source points.

Upsizing the existing loop system to 8 inch diameter lines will drastically improve the overall water pressure for each building.

The addition of the water tower will also help solve the water pressure issues throughout the campus by providing approximately 87 psi from the 8 inch diameter supply line out of the water tower to tie into the 8 inch diameter main loop line. The height of the water tower is determined by multiplying the head difference by 0.433 psi. We recommend the low level of the water tower to be 200 feet above the top of foundation. This will allow for a 12 psi pressure drop to the furthest point on campus and still have 75 psi available at the building inlet.

Upsizing of the loop system and adding an additional water source to the site will also help with consistent pressures throughout the campus. During maintenance when a section of the loop needs to be shut off or in times of emergency if a section of the loop were to fail, pressures in the system could be affected and the additional water source (water tower) would be utilized to compensate for any pressure losses in the system.

IRRIGATION

All irrigation lines are tied into the main water lines on the campus; therefore, it is only accounted for when determining the maximum daily demand for the emergency water supply volume. The irrigation water demand varies depending on environmental conditions and time of year. It is assumed the difference in the lowest water use in the winter or spring and the highest water use in the summer or fall is the irrigation water demand. The average daily demand for September and January were compared. The maximum daily irrigation demand is determined to be approximately 53,375 GPD. This amount was determined by taking the average irrigation demand for January and September and taking the difference between them to obtain the maximum daily irrigation demand.

The existing irrigation system is adequate and no changes are recommended.

SANITARY SEWER

At this time, the water use analysis indicates that no upsizing of the existing sanitary sewer lines will be required. Additional site surveys and further analyses are required in order to be certain that the existing sanitary sewer system will or will not need to be upsized.

STORM SEWER

Many storm structures were observed to be blocked or clogged by previous construction activities. AES recommends removing debris at storm inlets to maintain efficiency of the system.

The water tower requires a 6 inch diameter storm sewer drain and line to serve the tower in the event the tower needs to empty for emergencies or maintenance. The closest available line of adequate size to tie into is the 6 inch diameter storm sewer main running north to south under the parking lots west of Buildings 722, and 807 and directly south of Building 802. The drain and 6 inch diameter storm sewer line will need to be routed due south and tied into the closest existing 6 inch PVC sanitary sewer at from the utilities survey (Appendix A).

UTILITY MONITORING

METERING FOR USE

The VA Plumbing Design Manual section 1.5 requires the installation of building level utility meters in new major construction and renovation projects in order to accurately track and continuously optimize performance to measure consumption of potable water, gas, steam, electricity, and thermal energy in all Federal buildings and other facilities and grounds. Section

4.7.1 of the VA Plumbing Design Manual provides the following requirements for metering for use:

a. All buildings greater than five thousand square feet shall install building-level advanced utility meters for electricity, natural gas, and/or steam, if used. In addition, install advanced utility meters for steam condensate, chilled water, hot water, domestic water, and/or potable water if used.

b. Install sub-meters for cooling tower makeup water and boiler makeup water.

c. Energy or water intensive operations (i.e. laundry facilities, kitchen operations and data centers), regardless of size, must be similarly metered.

d. Advanced meters or metering devices and supporting systems (e.g. transmitters, web connections) must provide data at least once every 15 minutes.

e. In addition to providing data to building operators, building-level meters must transmit meter data directly to the existing data aggregation device in use at the facility.

f. Projects involving metering or installation of a data aggregation device must follow VA Master Construction Specifications Section 25 10 10, advanced utility metering system.

g. Install advanced water meters on all water wells installed on VA-owned property for agency use.

Additionally, section 4.7.2 of the VA Plumbing Design Manual requires analog gauge and electronic sensors/devices shall be used in tandem as much as is practicable. The gauge device functions as a provider of a local or immediate indicator of current conditions for troubleshooting and verification purposes. The electronic sensor/device is used for continuous monitoring of water conditions which shall be connected to the building automation system. In addition, all electrical devices shall be on emergency power and all measuring devices shall be calibrated in accordance with the manufacturer’s recommendations.

COMPONENTS OF HEALTHCARE-ASSOCIATED (HCA) LEGIONELLA DISEASE (LD)

The VA Plumbing Design Manual Section 4.5.5.2 requires the installation of a chlorinator. Shock chlorination involves the addition of chlorine to the water system in order to disinfect the water system. One way that low level chemical disinfection of potable water systems can be accomplished is through the use of U.S. Environmental Protection Agency (EPA) approved biocides. High level disinfection for new installations and/or maintenance of piping, equipment, and components must be conducted in accordance with the requirements of the International Plumbing Code (IPC 2015), American Water Works Association (AWWA C651-05), and VA Master Construction Specifications. Thus the Healthcare-Associated (HCA) Legionella Disease (LD) prevention plan is required to include, but not limited to:

Schematic (single line) diagrams of the site distribution and domestic water systems (hot and cold): Each diagram is required to be kept current and include diagrams of how the water is distributed, circulated, stored, heated, cooled, treated and monitored. The diagrams must also be accurate representations of existing conditions and focus on the main areas of water distribution and processing system(s) as well as identify any areas in which water is processed differently (e.g., hemodialysis and sterile processing, etc.). Further information on what comprises a schematic diagram will be provided by the VHA Water Safety Program.

A thorough risk assessment of the building for HCA LD: An annual assessment of the building for factors that may be indicators of increased risk for HCA LD is required. Factors include, but are not limited to: patient population risk factors, presence of building units associated with increased risk (e.g. transplant units), past cases of HCA LD, ability to implement engineering controls to prevent Legionella growth, past positive environmental testing results, and location of the building in an area of the country with recognized higher incidence of LD. Implementation of any/all previous years’ HCA LD plans and their findings shall also be included in the risk assessment.

Identification of water system management points for each building’s potable water distribution system(s) and where monitoring and controls can be implemented to prevent the growth of Legionella and prevent scald injury based on the schematic diagrams.

Establishment of engineering control strategies. Specifically, the HCA LD Prevention Plan must:

Establish the engineering control limits for each strategy to inhibit Legionella in the environment.

Identify control mechanisms for preventing scald injury from water that is too hot to touch.

Establish a schedule to routinely monitor implementation of the control strategies. It is important to note that the VHA Directive 1061 focuses on the implementation of engineering controls to prevent Legionella growth, “monitoring” refers to assessment of the levels of the control measures (e.g., water temperature, biocide level) in the water distribution system and water quality and not the amount of Legionella. Instead, assessment of Legionella in the water distribution must be included as a mechanism to validate that the engineering controls are effective.

Establish a dead-leg elimination and prevention plan. The plan components shall include but are not limited to: identification of existing dead-legs, dead-leg risk assessment, removal prioritization, removal schedule, and prevention.

Documenting when each water quality and control measure was monitored for condition compliance and corrective action taken (what and when).

Validation that the control measures and effectively inhibiting Legionella growth.

Process flow diagrams of the different control strategies and monitoring for each building’s hot and cold water distribution systems. Each diagram will focus on main areas of water distribution and processing as well as identify any areas in which water is processed differently (e.g., hemodialysis and sterile processing, etc.).

CONTROL STRATEGIES FOR ONGOING PREVENTION OF LEGIONELLA GROWTH

The primary control measures used to inhibit Legionella growth in the potable water distribution systems of buildings where patients, residents and/or visitors stay overnight is the maintenance of appropriate water temperatures and implementation of biocide. Each building’s potable water distribution system(s) shall be maintained and monitored in accordance with the following requirements.

WATER QUALITY AND PRESSURE MONITORING

Potable water entering each building subject to the Veterans Health Administration (VHA) Directive 1061 shall be continuously monitored for incoming water pressure along with the following characteristics: temperature, pH, dissolved solids, and oxidant residual. These are dependent upon local conditions and whether water treatment systems are installed and operated. Thus, additional monitoring of water characteristics and contaminants may be required.

WATER TEMPERATURE

The VHA requirements for water temperature limits for Legionella control in the building’s potable hot and cold water distribution systems are as follows:

Hot Water Distribution Systems: If a building uses domestic hot water storage tanks, water temperature of all such storage tanks must be maintained at a minimum of 140 degrees Fahrenheit (˚F) (60 degrees Celsius (˚C)) to prevent Legionella growth. The minimum discharge temperature for instantaneous and semi-instantaneous heat exchangers must be 130˚F (54.4˚C).

Water in the potable hot water distribution system piping must be no lower than 124˚F (51.1˚C) (prior to any temperature-reducing mixing valve or anti-scald device at the water outlet). To limit the risk of scald injury, hot water in the distribution system piping should be maintained at the lowest temperature that will ensure the minimum of 124˚F (51.1˚C) throughout.

Cold Water Distribution Systems: Legionella can grow in the building’s cold water distribution system as water temperatures increase above 67˚F (19.4˚C). Cold water temperature throughout the system should be maintained at or below 67˚F (19.4˚C) to the greatest extent practicable to inhibit growth. Use of piping system insulation, automatic drain devices and recirculation can limit the rate and duration of increased temperatures within the cold water distribution system.

Based on local conditions and validation testing, modifications, upgrades and supplemental cooling of the cold water distribution system may be required.

WATER TEMPERATURE MONITORING

The water temperature in the hot and cold potable water distribution systems must be monitored continuously in order to determine if temperatures are within the established control limits. At a minimum, temperature monitoring must be conducted in the following types of areas: incoming water supply to the building, water storage tanks, hot water discharge at the hot water source equipment, hot water return proximal to the hot water source equipment, water at the return of circulation loops, and water supplied to representative outlets (e.g. loop or branch, hydraulic remoteness, flow).

WATER TEMPERATURE CONTROL AT THE OUTLET

Buildings subject to the VHA Directive 1061 must minimize the risk of scald injury to patients, residents, staff and visitors. The use of thermostatic mixing valves and anti-scald devices on all outlets where people access water from the potable hot water distribution system are required in order to prevent scald injury. The water temperature delivered from the outlet must not exceed 110˚F (43.4˚C). See Appendix F for specific requirements and guidelines for the prevention of injury.

BIOCIDE

Oxidizing agents have a long history of being utilized by municipal water treatment facilities in order to inhibit bacterial growth in public water supplies. Implementing systems to deliver oxidizing agents and other biocides in building water distribution systems can be effective in inhibiting bacterial growth. However, their successful operation requires careful oversight for effective and safe use. For all buildings subject to the VHA Directive 1061, the following includes the requirement to assess the quality of incoming water as well as guidance and recommendations on the event that a VHA medical facility decides to implement biocide-based water treatment system(s) in such buildings.

1. Oxidant residual levels in the building(s) incoming water supply and at all representative outlets must be assessed. The assessment will determine if any disinfectant water treatment from the municipality or other potable water source is present when the water reaches the building and after distribution in the building. These values will help to determine if oxidant residual levels are at a sufficient level to suppress Legionella growth and will contribute to the information available if deciding whether or not to install a Legionella treatment system(s).

a. Monitoring the oxidant residual level in the incoming water supply shall be continual. Monitoring the oxidant residual in water suppled to representative outlets (e.g. loop or branch, hydraulic remoteness, flow, is also to be continual).

b. Minimum concentrations of oxidant residual necessary for inhibition of Legionella growth may vary from building to building. In general, the following minimum detected oxidant residual levels at hot and cold water outlets are suggested as guidance: 0.5 milligrams (mg) per liter (L) for chlorine (as free chlorine), 0.5 mg/L for monochloramine, and 0.3 mg/L for chlorine dioxide. These concentrations are considered guidance as facilities may find that higher or lower levels are needed for Legionella growth inhibition in their buildings(s) based on local conditions and environmental testing for Legionella.

2. Facilities may also choose to implement a systemic supplementary water treatment system(s) in buildings in order to supplement municipal or source treatment of water.

Some important factors to consider for this decision include but are not limited to: the levels of oxidant residual in the incoming water supply and/or at the outlets, past history of healthcare associated (HCA) Legionella disease (LD), and results from any environmental and clinical validation testing. If the facility decides to install a supplemental water treatment system in any building(s), then the following actions are required:

a. Any biocides for use in systemic water treatment systems must be specifically approved/recognized for the intended use by the State regulatory water authority. The VHA recognizes the U.S. EPA approved oxidants (chlorine, monochloramine, and chlorine dioxide) as acceptable disinfectants for use in potable water distribution systems. Use of an alternative biocide is permitted only if the facility obtains a waiver (subject to its conditions and duration). Information on the waiver process can be obtained through the VHA Water Safety Program.

b. The Facility Water Safety Committee must then determine the appropriate type of supplemental water treatment system for the building(s). The facility must consult with the State (or its delegated local water authority) for regulating drinking water for guidance on system selection, achieving an appropriate biocide residual level at building outlets for Legionella growth suppression, system design, system operation, and ensuring compliance with regulations regarding water treatment system(s) and safety. Once a type of system is selected, either the State (or its delegated local water authority) or the manufacturer of the system must provide the minimum and maximum outlet biocide levels in writing for both hot and cold water.

c. Biocide Residual Monitoring: The biocide residual levels of the water at distal water outlets in the hot and cold potable water distribution systems needs to be monitored to determine if levels are within the established control limits and if they are in compliance with regulatory requirements. Additionally, they must comply with regulatory requirements for contaminant monitoring frequency and locations.

FLUSHING

Regular flushing of hot and cold water at outlets (e.g. sink taps, showers), particularly those not in routine use or which experience low water flow (such as BLDG 645), is necessary to ensure that engineering controls are maintained at sufficient levels for Legionella growth inhibition throughout the water distribution systems and at fixtures. For irregular use or low flow fixtures, they must be flushed at least twice per week to prevent water stagnation for extended periods of time.

CORRECTIVE ACTIONS

If routine monitoring determines that the water temperatures or biocide residual levels from an installed system are not within the established limits, then at a minimum, the following actions must occur:

1. Assess the reason(s) why the control(s) were not within the established limit.

2. Corrective actions must be undertaken promptly, based on the assessment, to satisfy implementation of the control measures within established limits.

3. Re-assess the controls measures after corrective actions are implemented to determine if the water system management point is within the established parameters. If not within the established parameters, reassess the corrective actions, and implement revised corrective actions.

DOCUMENTATION

Water temperature and biocide residual testing, as well as corrective actions, must be documented to provide verification of implementation and monitoring.

PROGRESS REPORTING

Effective March 15, 2015 and then annually, the Veterans Integrated Service Network (VISN) Director must provide the VHA Water Safety Program with a progress report on actions taken to meet the implementation requirements for every medical facility within the VISN. If the engineering controls (i.e., water temperature and biocide treatment system, if chosen) are not implemented fully, the VISN Director’s progress report(s) are to be submitted semi-annually and must include any expected completion dates and supplemental actions taken.

VALIDATION OF LEGIONELLA PREVENTION

Validation focuses on collecting and evaluating information to determine if the engineering controls are effectively controlling Legionella growth in the building’s potable water distribution systems. See Appendix F for the validation requirements, which include both a clinical component to assess incidence of HCA LD and an environmental component to assess the presence of Legionella in the water distribution system.

SUPPLEMENTAL ACTIONS

Until the primary prevention strategy (i.e., water temperature and biocide treatment system, if chosen) is implemented fully, supplemental actions may be necessary to prevent and/or assess Legionella growth in building water distribution systems based on local conditions and validation results. If a building meets the primary prevention requirements, the medical facility may also choose to implement these measures based on local considerations.

ENVIRONMENTAL WATER TESTING FOR LEGIONELLA

Facilities may consider increasing the frequency of environmental water testing for Legionella during the year beyond the testing frequency required by the VHA Directive 1061 based on local risk assessment (e.g., history of HCA LD, patient population, ability to implement engineering controls) to determine if additional control procedures need to be implemented.

SUPPLEMENTARY WATER TREATMENT MEASURES

Supplementary treatment measures that suppress Legionella growth and minimize the risk of exposure may be ongoing and systemic, immediate and systemic, or directed at a certain portion of the water distribution system. Supplementary water treatment measures must be maintained according to the manufacturer’s specifications and in strict compliance with State regulations and operating permits. Supplementary water treatment measures need to be identified in the process flow diagrams and control limits identified. The systems must be monitored and adjusted in a timely manner, if indicated, to ensure operation at a capacity to inhibit the growth of Legionella.

Documentation of system verification and maintenance activities is required.

POINT OF USE FILTERS

Point-of-use filters may be installed at specific outlets to prevent Legionella exposure to patients.

This method may be of particular use in areas that treat high-risk patients.

EMERGENCY REMEDIATION OF THE POTABLE WATER DISTRIBUTION SYSTEMS

Emergency remediation of a building’s potable water distribution system(s) is triggered, at a minimum, by certain occurrences: identification of a definite HCA LD case, identification of a possible HCA LD case and Legionella-positive water results, or identification of Legionella-positive water results during routine environmental testing. See Appendix F (Clinical and Environmental Validation of Primary Engineering Controls for Prevention of Legionella Growth) for specific requirements and detailed information for assessing when emergency remediation is to be conducted.

1. Emergency remediation is to include any or all of the following immediate procedures:

a. Thermal Eradication: This procedure involves the temporary resetting of the temperature in the hot water distribution system(s) to 160˚F - 170 ˚F (71 ˚C - 77 ˚C) while continuously flushing each outlet in the system for at least 30 minutes.

Consideration needs to be given as to the feasibility of implementing thermal eradication depending on the design of the mixing valves in place. Since there is a significant risk for scalding at the water temperatures used for thermal eradication, extreme care must be taken to protect end users of the water distribution system(s), as well as employees who are administering the measure.

b. Shock Chlorination: This method involves increasing the chlorine level of the hot and cold water distribution systems to at least 2 mg/L and maintaining that level throughout the system for at least 2 hours (but not exceeding 24 hours) and flushing all outlets. Chlorination of the hot water tank(s) or the water heater(s) to a concentration of 20 to 50 mg/L may be required to achieve this level of free chlorine residual. After the shock chlorination procedure is complete, the system must be thoroughly flushed before reuse. If post-shock chlorination water testing indicates that Legionella bacteria are still present in the water distribution system(s), it may be necessary to repeat shock chlorination with consideration for use of a higher concentration of chlorine (e.g., at least 10 mg/mL free chlorine residual throughout the system and at outlets for 24 hours or 200 mg/L for three hours.

2. Thermal eradication and shock chlorination are temporary measures. After emergency mitigation, perform environmental testing to determine the effectiveness of the mitigation action. Legionella will likely reappear if proper routing water temperatures or residual biocide levels (or other supplementary systems or processes) are not maintained.

3. Prior to the implementation of emergency mitigation, stakeholders at the facility must be informed that this process will take place in order to facilitate safe implementation of the emergency procedures. After mitigation process is complete, communication must occur to inform stakeholders that the water is acceptable for general use. The facility must document any emergency mitigation processes that take place.

SPECIAL USE WATER SYSTEMS

It is important to consider the implications of Legionella mitigation strategies on special use water systems within the building such as the hemodialysis areas, laboratories, pharmacy, compounding, etc . Chemical disinfectants may result in the introduction of products into, or the formation of disinfection byproducts in, the building water supply at concentrations that may be toxic to patients on hemodialysis. Accordingly, the impact of mitigation strategies must account for potential toxicity, methods for removal of the chemical agent and byproducts from the special use water system, and availability of assay methods to measure the chemical agent and byproducts for assuring patient safety. Employees responsible for the oversight of special use water systems are to be consulted during the development and implementation of water treatment strategies for Legionella and promptly notified of any changes in treatment procedure.

PLUMBING

SEISMIC REQUIREMENTS

Earthquake-resistive design for plumbing equipment and piping shall comply with the requirements of VA Publication H-18-8, Seismic Design Requirements.

HISTORICAL WATER DATA

The following tables give the historical water usage data of the campus from October 2015 to December 2017 followed by the monthly averages for each month based off of that data.

TABLE 1 – HISTORICAL WATER DATA OCT ’15-DEC ’17:

TABLE 2 – HISTORICAL MONTHLY AVERAGE WATER USAGE:

EXISTING POTABLE WATER ISOLATION VALVES

The following shows all of the existing isolation valves for the potable water system. Reference survey in Appendix E for continuation.

TABLE 3 –…