Wisconsin cross connection control performance test registration 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by filling out the 'Owner Information' section. Clearly print your name, address, and contact details in ballpoint pen.
  3. Next, provide 'Facility Information' including the facility name, address, and assembly details such as manufacturer and model.
  4. In the 'Water Supply Source' section, select either 'Municipal Water System' or 'Other than municipal'.
  5. Proceed to complete the testing fields. For each check (1st and 2nd), indicate whether it closed tight or leaked and record static PSID values.
  6. Finally, certify the test results by printing your name and signing at the bottom of the form before submitting.

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The Cross Connection and Water Pollution Control Program identifies cross connections through the inspection and evaluation of a consumers water supply to determine whether solid, liquid or gaseous pollutants or contaminants are allowed to enter the potable water system.
5110 BACKFLOW PREVENTION ASSEMBLY TESTER REQUIREMENTS Successful completion of a minimum 40-hour training course on backflow assembly testing covering all aspects of ASSE 5110. Successfully passing a 100-question exam with a score of 70% or higher.
The Environmental Health Division conducts cross-connection control inspections within water users premises and at recycled water use areas to ensure that the drinking water supply is not connected to potential sources of contamination.

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