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Backflow Test Report Form - Town of Clayton

Backflow Test Report Form - Town of Clayton 2026

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The document is a Backflow Prevention Test and Maintenance Report for the Town of Clayton, detailing the testing and maintenance of backflow prevention assemblies. It includes information on customer details, assembly types, manufacturer specifications, test results for check valves, and any repairs made. The report certifies that the assembly operates according to industry standards and requires all repairs to be completed within 30 days.

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Click ‘Get Form’ to open the Backflow Test Report Form in the editor.
Begin by filling in the 'CUSTOMER' and 'STREET ADDRESS' fields to identify the property being tested.
Specify the 'LOCATION OF ASSEMBLY' and select the 'TYPE OF ASSEMBLY' from options such as RP, DC, or PVB.
Enter details for the 'MANUFACTURER', 'MODEL', and 'SERIAL NO.' of the assembly for accurate record-keeping.
Document line pressure readings and check valve performance by filling in fields like 'OPENED AT', 'CLOSED TIGHT', and any leaks observed.
Complete sections regarding repairs made, including any replacements of rubber kits or assemblies, ensuring all actions are noted.
Finally, certify the accuracy of your data by signing off with your name and certification number before saving or sharing the completed form.

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2009	4 Satisfied (26 Votes)

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What is a backflow test report?

Average cost of backflow testing Backflow testing costs $30 to $300 per device, depending on the location and whether the test finds any issues. Backflow preventers require testing annually to make sure theyre working properly and your water isnt contaminated.

How much does it cost to get a backflow tested?

The State of North Carolina requires backflow prevention assemblies be installed on all cross-connections to help keep our water supply safe. These assemblies must be regularly tested and certified to ensure that they are working properly.

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Backflow Test Report Form - Town of Clayton 2026

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