Unless otherwise indicated, all general requirements apply to both new construction and an existing nursing home. Plumbing. Plumbing shall be installed in conformance with all applicable federal, State, and local codes and ordinances. Plumbing and water supplies shall be protected against backflow within a nursing home. Prevention of backflow shall be ensured by proper installation of: Plumbing cross-connections; Submerged inlets; and Back siphonage. Sewage. The nursing home shall be serviced by a public sewage disposal system if available. Private Sewage Disposal Approval. If no approved public sewerage system is available, a private sewage disposal may be used, if it is approved by the Department. Private sewage disposal systems shall comply with COMAR 26.04.02. Water Supply. A nursing home shall be served by water from a safe public water supply, if available, as determined by the Department. Approval of Private Water Supply. If a safe public water supply is not available, a private water supply may be used if it is approved by the Department. Private water systems shall comply with all federal, State, and local requirements. Emergency Procedures. Emergency procedures shall be established and documented that enable the nursing home to provide water in all essential areas in the event of the loss of the normal water supply or if the nursing home would have to shelter in place during an emergency or disaster. These written procedures shall: Be a part of the nursing home’s Emergency and Disaster Plan, in conformance with Regulation .40 of this chapter; and Describe the nursing home’s plan to ensure that there is an adequate amount of safe drinking water for all residents and staff for a minimum of 72 hours. Adequacy of Pressure. The water supply shall be adequate in quantity and delivered under sufficient pressure to satisfactorily serve equipment in the nursing home. A minimum pressure of 15 psi during demand period is required at top floor equipment. Temperature. The water heating equipment shall supply adequate amounts of heated water according to the following temperature guidelines for: Resident use, the water temperature shall be between 100°F (38°C) and 120°F (49°C): Washing; Bathing; and Other personal use; Food preparation use, as referenced in COMAR 10.15.03; and Laundry use, as referenced in the 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings.