Get Backflow Test Form - City Of Bellevue

Completing the Backflow Test Form for the City of Bellevue is essential for maintaining water quality and ensuring compliance with local regulations. This guide provides clear and supportive instructions to help users navigate the form effectively, whether they are familiar with the process or not.

Follow the steps to complete the Backflow Test Form online.

1. Click ‘Get Form’ button to begin the process of accessing the Backflow Test Form and open it in your preferred document editor.
2. Enter the account number in the designated field at the top of the form.
3. Provide the name of the premise in the space provided and indicate if it is a commercial or residential property by checking the appropriate box.
4. Input the service address with the city and ZIP code.
5. Fill in the contact person's name and provide their phone number and fax number, if applicable.
6. Specify the location of the backflow assembly and downstream process by checking the corresponding box for DCVA, RPBA, PVBA, or other.
7. Indicate whether this is for a new installation, existing assembly, or replacement by checking the appropriate box.
8. List the make and model of the assembly, including the serial number.
9. Record the results of the initial test, noting if the proper installation was confirmed by selecting yes or no.
10. Detail the air inlet measurements and whether the assembly passed or failed the test.
11. Document any repairs done, including if parts need to be cleaned, replaced, or if the assembly did not open.
12. For the air gap inspection, confirm if the minimum air gap separation is provided by marking yes or no.
13. Provide a detector meter reading, remarks, and line pressure in the specified fields.
14. Complete the signature section by including the tester's name, certification number, and date, and ensure final tests are recorded.
15. After filling in all necessary fields, save your changes, download the completed form, print for your records, or share it as required.

Complete your Backflow Test Form online today to ensure compliance and proper documentation.