Get Backflow Device Test Report - Prince William County Service Authority

Filling out the Backflow Device Test Report is essential for ensuring that backflow devices perform correctly and meet regulatory standards. This guide provides step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to complete the report online.

1. Click ‘Get Form’ button to access the Backflow Device Test Report and open it in your preferred editor.
2. Enter the date of the test in the designated field. Ensure the date is accurate to maintain compliance and record-keeping.
3. Fill in the cross connection account number, which identifies the service account for the backflow device.
4. Provide the name of the premises where the backflow device is located, followed by the service address for proper identification.
5. Indicate the location of the device on the property. This helps inspectors easily find the device during inspections.
6. Specify the device supply type, such as fire, irrigation, or domestic, to clarify its intended use.
7. Record the device type by entering the ASSE number which aligns with the device's certification.
8. Input information regarding the device's manufacturer, model, and serial number for identification purposes.
9. Note the size of the device, which should correspond to the specific application requirements.
10. Document the line pressure at the time of the test in pounds; this is crucial for evaluating the performance of the device.
11. Conduct the initial test for both check valves, recording whether they held pressure or leaked, and whether they closed tightly.
12. Test the relief valve for check valve #1 and check valve #2, noting the pressure at which it opened and if it did not open.
13. Proceed to the final test, repeating the steps for assessing pressure holding and leakage for both check valves.
14. Record the air inlet and check valve pressures at the designated stages.
15. In the remarks/repairs section, include any additional comments about the test or repairs needed.
16. Provide details about the test gauge used, including the manufacturer's name, model number, serial number, and calibration date.
17. Fill in the information for the certified tester, including their name, company name, email address, and phone number.
18. Complete the certification statement by signing and entering the DPOR license number.
19. Review all entries for accuracy before submitting the report.
20. Users can then save changes, download the completed report, print it, or share it as needed.

Complete your Backflow Device Test Report online to ensure compliance and timely submission.