Backflow test form pdf city of portsmouth va

We only accept accurate, complete, and original test forms. This program will require that every commercial and industrial establishment be individually inspected by a city inspector to determine if any backflow situation exist on the site. James city county government center 101 mounts bay road williamsburg, va 23185 contact us. Backflow assembly test form searcy water utilities. A5012717certv3 board for contractorsbackflow cert app 01012016 page 2 of 3 9. Appendix a backflow testers list and bpa test form. It is the customers responsibility to have the test done by a certified backflow prevention device worker and verify that a completed test form showing that the device has. Pressure vacuum breaker requirements initial test repairs retest air vent opened at min. Thank you for your patience and willingness to do your part to help our city meet its state regulatory obligations. Customers with testable backflow prevention devices will receive notification and a blank test form from the city before the test is due.

Portsmouth, va 23704 7573938561 city of suffolk 272 benton rd. I hereby certify that the above backflow prevention device has been in constant use at this location during the entire prescribed interval between test periods and during that. Our software generates controlled numbers for each testable device. The city of lynchburg, virginia department of utilities backflow prevention assembly test report 525 taylor streetlynchburg, va 24501 phone. Otherwise, the tester may submit results for any backflow assembly test by using the city of fullerton s standard blank test report form available online. Contamination from crossconnections backflow of water from a customers plumbing into the public water system has the potential to contaminate public drinking water and cause he alth concerns. Charlotte mecklenburg backflow test information request. Often, a check valve is a common form of backflow prevention. It is the customers responsibility to have the test done by a certified backflow prevention device worker and verify that a completed test form showing that the device has passed the inspection has been. Backflow prevention assembly test and maintenance report type of assembly the backflow prevention assembly detailed below has been tested and maintained as required by tceq regulations and is certified to be operating within acceptable parameters. Mail completed form to cross connection control 2881 harper road, melbourne, fl 32904. I have made the above test and hereby certify that this backflow prevention device. There is no fee associated with submitting this form. Software designed for the backflow tester by the backflow tester for the cheapest price.

According to the virginia department of heath waterworks regulations 12 vac 5590580, the city of richmond must establish and enforce a program of cross connection control and backflow prevention to protect the citys water distribution system, and to ensure that the systems treated water is pure and safe for public consumption. Room 115 richmond, virginia 23219 804 6468544 fax 804 6463438 submit form backflow preventer is located between the water meter and first branch yes no domestic fireline irrigation device type. The citys water and sanitary sewer system consists of over 420 miles of water mains and 309. The current addition of the portsmouth city pool code requirements has. Additional information can be found on the backflow prevention program page. Here you will find forms broken up by departments, these departments include. Differential pressure circle one leaked closed tight circle one leaked closed tight diff press diff press repairs and new materials test after repairs circle one circle leaked leaked closed tight closed tight circle one. A manual fire alarm system is not required in buildings. The state requires all water utilities to complete an inventory survey of all properties in their territory to be sure every location which requires backflow prevention devices has. Please complete one certification form for each device. Passing attendees shall receive a certificate and a limited or general license. Pdf backflow test form with electronic signature pdf contact us.

This division is responsible for the operation, maintenance, and protection of the departments water resources reservoirs, deep wells, watershed, forestry and fishing programs and the water treatment plant and for insuring the production and delivery of high quality drinking water through its water quality programs laboratory, testing, monitoring, and backflow and crossconnection. City of columbus, division of water backflow compliance 918 dublin road building 918 columbus, ohio 432159052 fax 6146450290 customer and property information please print. The above report is certified to be true at the time of the test. City of arlington, tx backflow prevention home page. This form must be signed by all parties master plumber, certified tester, owneragent as.

Indicate if and when the device has been replaced and if the serial number has changed. If you would like to become a backflow prevention assembly tester than this application needs to be filled out. Backflow prevention device test form must be completed by certified backflow device tester. Va 23608 7572344888 city of portsmouth 430 meander rd portsmouth, va 23704 7573938561 city of suffolk. If you do not have the correct test forms, please call our office at 7572344885 or 7572344888 to receive them.

Virginia board for contractors approved backflow prevention device worker schools approved to provide individual training for backflow prevention device installation incidental to highway heavy, landscape irrigation, and fire sprinkler contracting jobs. Water distribution 625 laguna street santa barbara, ca. The virginia uniform statewide building code usbc is a state regulation. The backflow assembly worker course is a rigorous fiveday course that meets all american backflow prevention association standards for certification in. Assembly test forms and the most current list of certified testers are also available on the internet at. Testers should use city of virginia beach test form. Field operations provides a 24hr emergency response for water and sewer related problems in the public utilities owned systems. Please copy and complete the attached form for backflow prevention testing and certification. Centrifugal pump performance is measured by two forms of output. Backflowprevention assembly test report 09 city of columbus.

Backflow device annual testing city of virginia beach. Customer backflow information list of backflow test companies. Backflow prevention device city of harrisonburg, va. Sample permission and hold harmless agreement pdf city park use.

Forms being developed 2 we are improving the experience daily. The following is a list of forms for the city of portsmouth which may be printed on. The james city service authority jcsa a program of surveying,administers inspection, and testing of all backflow prevention devices within the jcsa and assemblies water distribution systems. A plumbing permit for a backflow device is required for any new construction, alterations, additions, andor other types of plumbing work performed in relation to a backflow device in the city of harrisonburg. The dpd pool water test kit does not measure combined chlorine. Backflow assembly test report city of richmond, british. Text to 7043927181 with your name and email address.

September 22, 2015 attach fee paid sticker backflow assembly test report plumbinggas inspections section 6911 no. Preprinted backflow test report forms, containing the make, model, size, serial number and site location, can be obtained for any existing backflow by contacting the water quality specialist. Portsmouth city hall contact us 801 crawford street portsmouth, va 23704 phone. Cross connections city of norfolk, virginia official. Portsmouths program seeks to correct crossconnections throughout the city and eliminate the potential for backflow by conducting inspections of the plumbing of new and existing businesses and industries. The backflow prevention assembly worker is needed by administrative authorities in virginia to assure the backflow prevention assemblies installed continue to protect the drinking water. Utilities department forms the official site of rio. The virginia uniform statewide building code usbc is a state regulation promulgated. Business forms the following is a list of forms for the city of portsmouth which may be printed on your computer. The backflow device is owned and maintained by the property owner and the testing is performed by our certified backflow testers. Charlotte mecklenburg backflow test information request form alternatively, you may take a picture of the notice letter. Pdf that the backflow preventer has passed its inspection.

Best 28 backflow prevention testing in portsmouth, va with. Backflow prevention assembly test report failed, illegible or incomplete reports will not be accepted please return to. Backflow test form preprinted test forms are provided to the customer with the annual notification letter, with the hand delivered a 30 day letter, and when they. We only accept accurate, complete, and original test form s. In most cases, the law requires a double check dc, n reduced pressure principle devicerp device or an air gap when backflow prevention is mandated. The city of lynchburg, virginia department of utilities. Covid19 updates city facilities closed to public until further notice. Admission tax registration form pdf this form allows you to apply to collect admission tax.

Admission tax registration form pdf this form allows you to apply to. The portsmouth health departments pool operation and. Backflow can occur if a crossconnection exists between the public water system and other water or chemicalfilled systems, such as. Do you hold a current backflow prevention device worker license, certification or registration issued by any outside of. Virginia uniform statewide building code division of legislative. This backflow prevention and cross connection controlprogram is ongoing in nature and was devised and implemented with security of the potable water.

The city of manassas park in compliance with the safe water act has implemented a program to protect the community distribution system from possible backflow conditions. Testers should use city of virginia beach test form tag backflow device once annual test is complete. Plant in chuckatuck, and the city of portsmouth water treatment plant located within the core city. If you need your backflow prevention assembly tested or you are an approved backflow tester you will. This division also operates and maintains the citys sewage collection system and transmission system, which consists of sewage mains, manholes, and sewage pumping stations. If you have any questions or comments call 75189660 notice. In the richmond, the epa holds local water suppliers responsible for maintaining a certain amount of purity in potable water systems. There are approximately 1668 backflow devices in the portsmouth system.