Backflow Prevention Device Test Form - Instructions
This Backflow Prevention Device Test Form is essential for certified testers to accurately report backflow prevention device tests. It provides clear fields for necessary data, ensuring compliance with regulations. Use this form to submit vital information to Pennsylvania American Water.
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How do I fill this out?
Filling out this form is straightforward. Begin by gathering all necessary information about the backflow prevention device and its testing. Complete each section carefully, ensuring accuracy to facilitate proper processing.
How to fill out the Backflow Prevention Device Test Form - Instructions?
1
Gather necessary information for the backflow device.
2
Fill in the location and device details accurately.
3
Complete the testing sections with accurate data.
4
Obtain required signatures from the tester.
5
Submit the form to the appropriate authority.
Who needs the Backflow Prevention Device Test Form - Instructions?
1
Certified backflow device testers need this form to document their testing results.
2
Homeowners with irrigation systems require the form to ensure compliance.
3
Businesses with backflow prevention devices must use this form to maintain service.
4
Plumbers and contractors utilize this form for effective testing documentation.
5
Water utility companies demand this form for their regulatory requirements.
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Click on the text fields you wish to modify.
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Download the edited document to your device.
What are the instructions for submitting this form?
Submit the completed Backflow Prevention Device Test Form by email at paw.cc@amwater.com, or fax it to 570-341-3296. You may also mail it to the Cross Connection Department at 2699 Stafford Ave Scranton, PA 18505. Ensure you keep a copy of the submitted form for your records.
What are the important dates for this form in 2024 and 2025?
For 2024, the submission dates align with local regulations; keep an eye on any notices from Pennsylvania American Water. In 2025, updates may be announced for further testing requirements. Ensure your devices are tested annually to avoid any compliance issues.
What is the purpose of this form?
The primary purpose of this form is to ensure that backflow prevention devices are tested and maintained properly. It serves as official documentation that validates the functioning of these devices, protecting the public water supply. By collecting detailed data on testing results, this form plays an important role in regulatory compliance.
Tell me about this form and its components and fields line-by-line.
- 1. Premise Number: Unique identifier for the location being tested.
- 2. Account Number: Account linked to the service.
- 3. Customer Name: Name of the customer responsible for the service.
- 4. Service Address: Address where the service is provided.
- 5. Device Information: Details about the specific backflow device being tested.
- 6. Tester Information: Details about the certified tester performing the test.
What happens if I fail to submit this form?
Failing to submit this form may lead to compliance issues with local authorities. Regulatory bodies may impose penalties for not providing necessary documentation. Continuous non-compliance can result in severe repercussions for your water service.
- Regulatory Penalties: Non-submission can lead to fines and legal consequences.
- Service Interruption: Failure to document tests may result in service being suspended.
- Public Safety Risks: Not testing devices can lead to water contamination problems.
How do I know when to use this form?
- 1. Routine Testing: Used yearly for scheduled device tests.
- 2. After Repairs: Required after any maintenance or repairs on the device.
- 3. Regulatory Compliance: Necessary for compliance with local water safety standards.
Frequently Asked Questions
How do I fill in the backflow test form?
Begin by entering the premise and account numbers, then fill in the customer information and testing results.
Can I edit this PDF online?
Yes, you can edit the PDF directly on PrintFriendly before downloading.
What information does the form require?
The form requires details about the backflow device, testing dates, and tester information.
How do I submit the completed form?
Submit via fax, email, or mail to the Pennsylvania American Water's designated department.
Is there a deadline for submitting the form?
While specific deadlines may vary, timely submission is crucial for compliance.
What if I make a mistake on the form?
You can edit the PDF as needed before finalizing and submitting it.
Do I need to sign the form?
Yes, both initial and final test sections require the tester's signature.
Can I share this form with others?
Absolutely, once edited, you can share the PDF easily through various channels.
What should I do if my device fails the test?
Consult the relevant regulatory authority for guidance on rectifying the issue.
How often do I need to test my backflow prevention device?
Testing frequency varies by local regulations; ensure compliance with those guidelines.
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