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NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Public Water Supply Protection Empire State Plaza Corning Tower Room 1110 Albany, NY 12237 Report on Test and Maintenance of Backflow Prevention Device

How to fill out nys backflow test form

How to fill out NYS backflow test form?

1. Start by gathering all the necessary information about the backflow prevention device that you will be testing. This includes the make, model, and serial number of the device.
2. Next, carefully read through the instructions and guidelines provided with the form. Familiarize yourself with the specific requirements and sections that need to be completed.
3. Begin by filling in your personal information in the designated fields. This typically includes your name, contact details, and professional credentials if applicable.
4. Move on to the section where you will provide details about the property where the backflow device is installed. This may include the property address, owner's name, and contact information.
5. Proceed to document the specifics of the backflow prevention device. Include the make, model, and serial number as previously mentioned. Additionally, detail the size and location of the device within the property.
6. The following step involves recording information about the testing process itself. Indicate the date and time of the test, as well as the test results, including the device's pressure loss and any necessary repairs or adjustments made.
7. Ensure you accurately complete any other relevant sections required by the NYS backflow test form. This might include information about who conducted the test and their certification details.
8. Once you have carefully filled out all the necessary sections, carefully review the form for any errors or omissions. Make any necessary corrections before finalizing the form.
9. Finally, sign and date the form in the appropriate spaces to verify that the information provided is accurate and complete.

Who needs NYS backflow test form?

1. Individuals or companies that are responsible for testing and maintaining backflow prevention devices within the state of New York are required to fill out the NYS backflow test form.
2. This may include licensed plumbers, backflow prevention device testers, and professionals involved in water system maintenance.
3. Property owners or managers who are responsible for ensuring their property's compliance with backflow prevention requirements may also need to complete this form.

People Also Ask about nys backflow test form

What are the examples of backflow prevention?

Below are a few common types of backflow prevention assemblies: Pressure Vacuum Breakers. The pressure vacuum breaker (PVB) assembly is one of the most common types of backflow preventers. Spill-Resistant Vacuum Breakers. Double Check Valves. Reduced Pressure Principle Backflow Assembly.

How often does Title 17 require backflow assemblies be tested?

TESTABLE ASSEMBLIES: For the protection of your drinking water supply the backflow prevention assembly, as described on the reverse-side of this form, shall be tested at least annually pursuant to the requirements outlined in the California Code of Regulations, Title 17 § 7605, Los Angeles County Code, Title 11 § 11.38

Why do you need a backflow preventer?

Why is a Backflow Preventer Required on Lawn Sprinkler Systems? Lawn irrigation systems can backflow contaminated water into your drinking water. In order to prevent this, building codes require that these systems be protected with a backflow preventer: International Plumbing Code 2006 608.16.

What is a backflow prevention assembly tester?

Backflow prevention assembly testers are qualified to test and repair assemblies on any domestic, commercial, industrial, or irrigation service. Backflow prevention assembly testers may test and repair assemblies on firelines only if they are permanently employed by an Approved Fireline Contractor.

What is mean by backflow prevention?

A water backflow prevention device is a device that works to protect potable water from contamination or pollution due to backflow. In layman's terms, it's essentially a device that stops water from flowing backward in your pipes.

What is backflow explained?

0:25 2:18 A CRASH COURSE in Backflow Prevention - YouTube YouTube Start of suggested clip End of suggested clip And kind of dive into some of what actually goes into these systems yeah so backflow. Itself is justMoreAnd kind of dive into some of what actually goes into these systems yeah so backflow. Itself is just defined as the unwanted reverse flow of any liquid gas or solid uh in a system.

What is the need for a backflow?

Backflow is the reverse flow of detrimental and dangerous material into water mains. When there are connections between our water supply and sources of possible contamination it is potentially dangerous – and connections between drinking water lines and commercial and industrial plumbing systems can be deadly.

What is the purpose of backflow testing?

Why do I have to test my backflow assembly every year? Backflow prevention assemblies are installed to protect your drinking water from potential sources of contamination. The only way to ensure that they are working properly is to have them tested by a certified Backflow Assembly Tester.

What is backflow prevention report?

Backflow testing is a plumbing service that checks your backflow preventer device by assessing its pressure levels. When backflow is present, untreated or contaminated water can be back-siphoned into your clean water. For this reason, testing guarantees the water you use for drinking and showering is safe and sterile.

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What is nys backflow test form?

NYS Backflow Test Form refers to the official document used in the state of New York to record backflow prevention device test results. This form is usually completed by certified backflow prevention device testers who are required to test and inspect these devices regularly to ensure they are functioning properly and preventing the reverse flow of potentially contaminated water. The NYS Backflow Test Form includes details such as the tester's information, device information, test results, and any necessary repairs or maintenance conducted. This form serves as a record of compliance with state regulations and is often submitted to the appropriate authorities for review and verification.

Who is required to file nys backflow test form?

In New York State, property owners who have a backflow prevention device installed on their premises are required to file the NYS Backflow Test form. They should have the device tested annually by a certified tester, and the test results need to be submitted to the local water authority or municipality as a part of their compliance with state and local regulations on preventing water contamination.

How to fill out nys backflow test form?

To fill out the NYS (New York State) backflow test form, follow these steps: 1. Obtain the form: Download or obtain a physical copy of the NYS backflow test form. These forms are usually available on the website of the local municipality or water authority. 2. Provide general information: Begin by filling out the top section of the form, which typically requires information such as the name of the property owner, address, contact information, and the name of the backflow tester. 3. Test location details: Provide information about the location being tested, including the property address, unit/apartment number (if applicable), city/town, and ZIP code. 4. Backflow assembly details: Fill in the details of the backflow prevention device being tested, such as the make, model, size, and serial number. This information can usually be found on the device or its documentation. 5. Test results: Record the test results in the designated section. This may include checking boxes or filling in numerical values. Ensure that all required information, such as test pressures, is included accurately and completely. 6. Tester information and certification: Provide the contact information for the backflow tester, including their name, company name (if applicable), address, email, and phone number. The tester should also sign and date the form to certify that they conducted the test. 7. Owner signature: The property owner or authorized representative must sign the form, giving their consent and acknowledging the test results. 8. Submitting the form: Follow the instructions provided on the form to submit it. This may involve sending it by mail, email, or uploading it to the relevant online portal. Remember to review the specific instructions provided with the backflow test form as requirements can vary slightly between municipalities or water authorities in New York State.

What is the purpose of nys backflow test form?

The purpose of the NYS backflow test form is to document the results of a backflow prevention device test conducted by a certified tester. This form is used to ensure compliance with state and local regulations regarding the prevention of backflow, which is the reverse flow of water or other substances from a potentially polluted source back into the public water supply. The form includes information about the location and type of backflow prevention device, the testing procedures and results, as well as the tester's certification details. It serves as a record of the testing process and provides evidence of compliance with backflow prevention regulations.

What information must be reported on nys backflow test form?

The specific information required on a New York State backflow test form may vary depending on the local regulations and policies. However, generally, the following information is commonly reported on a backflow test form: 1. Property Information: The address of the property where the backflow preventer is installed. 2. Device Information: Details about the backflow prevention device, including its make, model, size, and serial number. 3. Installation Information: The date when the device was installed, the name of the company or individual who installed it, and any relevant installation permit numbers. 4. Test Information: The date of the test, the technician's name and certification number, and the testing company's name and contact information. 5. Test Results: The test results, including the pressure measurements, whether the device passed or failed, and any remarks or notes about the test. 6. Repairs or Maintenance: If any repairs, adjustments, or maintenance were performed during the test, they should be noted on the form along with the details. 7. Certifications and Signatures: There are sections for both the technician and the property owner to provide their signatures, confirming that the information provided is accurate. It is important to note that these requirements may change over time, so it is recommended to refer to the specific regulations and guidelines of the local jurisdiction in New York State where the backflow test is being conducted.

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