Get Backflow Test & Maintenance Form - The Town Of Collierville

Filling out the Backflow Test & Maintenance Form for The Town of Collierville is essential for ensuring the safe operation of irrigation systems and backflow prevention devices. This guide will walk you through the sections of the form step-by-step, making the process easy and efficient.

Follow the steps to complete the form accurately.

1. Click the ‘Get Form’ button to access the form and open it in your preferred editing tool.
2. In the 'Test Kit Type' section, specify the type of test kit used for testing backflow prevention devices, and enter the 'Test Kit Serial #' to ensure accurate identification.
3. Fill out the customer information by entering the 'Customer Name,' 'Customer Address,' 'Mailing Address,' and 'Responsible Person.' Be sure to include the correct ZIP codes and phone number.
4. In the 'Calibration Information' section, provide the 'Date Calibrated,' 'Type of Device,' and details of the individual or organization where the device was calibrated ('Calibrated By', 'Model #', 'Serial #', and 'Size').
5. Indicate whether the device is a 'New Install' or 'Replacement,' and enter the relevant 'Permit Number.'
6. In the 'Check Valve' sections, assess and report the condition of each check valve (Valves #1 and #2) by marking whether they are 'Close Tight' or 'Leaking.'
7. Document the details of the test results including 'TEST DATE', 'Open Pressure,' and 'Relief Valve Diff. Pressure.' Note the results of pressure drops and direction of flow for accuracy.
8. Answer the questions regarding whether the RP device serves a lawn sprinkler and if it was repaired or replaced. Include the old serial number if applicable.
9. Complete the 'Time' sections by noting 'Beginning Time,' 'Ending Time,' and the 'Total time O/S' spent on the testing.
10. The tester must certify the accuracy of the information by filling out their name, signature, firm's name, and phone number before submission.
11. Finally, save any changes made to the form. You can then download, print, or share the completed form as needed.

Ensure your backflow prevention device is compliant by completing the Backflow Test & Maintenance Form online today.