Test and Maintenance of Backflow Device Form - Suffolk County 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in the year at the top of the form, indicating whether this is an annual test.
3. Complete the SCWA Contract Account number and provide the facility name, address, and specific location of the backflow device.
4. In the Device Information section, specify whether it is an RPZ or DCV device, along with its manufacturer, model, size, and serial number.
5. Fill out the 'Test Before Repair' section by indicating if Check Valve #1 and #2 leaked or closed tight. Record the differential pressure relief valve opening pressure.
6. Document any repairs made in the designated area, including materials used and repairer’s details.
7. If repairs were made, complete the 'Final Test' section with results and date.
8. Finally, ensure all parties sign where indicated and complete their licensing information before submitting.

Start using our platform today to easily fill out your Test and Maintenance of Backflow Device Form for free!