Get Nc Cross Connection Control & Backflow Prevention Device Test And Maintenance Report - Town Of Cary 2017-2025

This guide provides detailed instructions on completing the NC Cross Connection Control & Backflow Prevention Device Test And Maintenance Report for the Town of Cary online. Users of all experience levels can follow these steps to ensure accurate and efficient form completion.

Follow the steps to fill out the report correctly.

1. Start by clicking the ‘Get Form’ button to access the report and open it in your online editor.
2. Fill in the 'Date' field with the appropriate date of the test.
3. In the 'Customer' section, provide the name of the customer or entity for which the report is being completed.
4. Enter the complete address of the customer in the 'Address' section, including street, city, and zip code.
5. Document the 'Name of Tester,' and ensure that the tester’s information is accurate.
6. Include the 'Company Name' of the testing entity.
7. Fill in the 'Testing Gauge Serial No.' as well as the 'Model No.' to ensure proper documentation.
8. Provide the 'Tester Certification No.' to confirm qualification.
9. List the 'Calibration Date' of the testing gauge.
10. For the 'Location of Assembly,' specify where the assembly is situated.
11. Select the type of backflow assembly by marking the appropriate box (RP or DC).
12. Input the 'Serial No.' and 'Water Meter No.' when applicable.
13. Indicate 'Line Pressure' by providing the PSI value.
14. Select the appropriate condition of the device: 'New Install', 'Existing Device', or 'Replacement Old Assembly Serial No.' if applicable.
15. Choose the service type of the assembly, such as 'Domestic,' 'Fire,' or 'Lawn Irrigation.'
16. For the 'Initial Test,' indicate if it’s a 'New Test' or 'Recertification Test.'
17. Record the performance of 'Relief Valve' and 'Check Valve #1' and '#2,' including measurements for PSID as needed.
18. Fill in the status of 'Shut Off Valve #1' and '#2,' ensuring to record if they closed tightly.
19. Submit 'Final Test' results including the PSID readings.
20. Document any 'Repairs' made, including options like 'Cleaned Only,' 'RV Assembly,' or 'Replaced Rubber Kit' if applicable.
21. Write any additional comments in the provided space to clarify any necessary details.
22. Ensure the tester signs the report in the 'Signature' section.
23. After completing all fields, you can save the changes, download, print, or share the form as required.

Take action now and complete your report online for prompt processing.