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Henry County Water Authority Backflow Prevention Test Report

Henry County Water Authority Backflow Prevention Test Report 2026

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The document is a Backflow Prevention Assembly Test Data and Maintenance Report from the Henry County Water Authority. It includes sections for recording account information, assembly details, test results, repairs made, and certifications of accuracy regarding the operation and maintenance of backflow assemblies.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your HCWA Account Number and Account Name in the designated fields. These are required for identification.
Fill in the Meter Number, Mailing Address, and Service Address to ensure accurate service records.
Specify the Installation Date and Location of Assembly. This information is crucial for maintenance tracking.
Select the Manufacturer and Type of Assembly from the dropdown options provided.
Record the Test Date, Model Number, Size, and details regarding initial tests such as time and type (e.g., Semi-Annual).
Complete sections for Check Valve No. 1 and No. 2 by indicating any leaks or repairs needed.
Finally, certify that all data is accurate by providing signatures for testing and repair personnel at the bottom of the form.

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