Attachment 1 - VA BFP Testing Forms.pdf
PDF 171 KB Posted
- Solicitation number
- 36C24126Q0744
About this file
This is a standardized test report form used by the New England Water Works Association (NEWWA) for documenting backflow prevention device assembly inspections and testing results.
The form captures comprehensive testing data for four primary types of backflow prevention devices: Reduced Pressure Backflow Prevention Device Assemblies (RPZ), Double Check Valve Device Assemblies (DCVA), Pressure Vacuum Breakers (PVB), and Spill Resistant Vacuum Breakers (SRVB). The form records property owner information, device specifications including make, model, size, and serial number, and testing details such as test kit calibration data. For each device type, the form documents specific pressure differential (DP) measurements and operational status of check valves, relief valves, and air inlet valves. Testing scenarios include flow and no-flow conditions, with pass/fail criteria for valve tightness and proper opening points measured in PSID (pounds per square inch differential). The form distinguishes between test occasions: installation tests, post-repair tests, annual tests, and semi-annual tests. Additional fields capture line pressure, protection type (service line at meter or fire service line), downstream shut-off valve condition, and whether testing was witnessed by water works officials or owner agents. The tester's certification number, signature, and overall test result (PASS, FAIL, or OTHER) are required, along with remarks and confirmation of service restoration.
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| Attachment 4 - Spec Sheet.pdf | ||
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| 36C24126Q0744.docx | DOCX document | |
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Text version
NEWWA Backflow Prevention Device Assembly Test Report Form
Owner of Property Date________________ Time ______________
Mailing Address Tested by:
Certificate #:
(City,Town) (Zip)
Contact Person RPZ DCVA PVB SRVB
Make ____________ Model No. ____________
Device Address and Location Size Serial No. _________
_____________________________________________________________ Test After Installation
Device Identification Number _____________________________________ Test After Repairs
Annual Test
Test Kit Serial # _____________________Calibration Date_____________ Semi-Annual
Reduced Pressure Backflow Prevention Device Assembly (RPZ) Pressure Vacuum Breaker (PVB)
Spill Resistant Vacuum Breaker (SRVB)
Check Valve
No. 1
Check Valve
No. 2 Tightness
Flow
Condition
Evaluated
Relief Valve
DP Opening
Point
Check Valve
No. 2 DP
Check Valve
DP
Flow Condition
Evaluated
Closed Tight
Leaked
Closed Tight
Leaked
Flow
No-Flow
Opened at PSID
Did Not Open
PSID
Double Check Valve Device Assembly (DCVA) Air Inlet Valve DP Opening Point
Backpressure Test Check Valve No. 1
DP
Check Valve No. 2
DP
Flow Condition
Evaluated
Opened at _________.______
Did Not Open
TC#1 PSI TC#4 PSI
At the time of the test, the downstream shut-off valve was: Closed Tight Leaked Not Tested
Line Pressure ___________PSI Protection Type: Service Line @ Meter Fire Service Line
Signature of Certified Tester
PASS FAIL OTHER
Test Witnessed by:
Water Works Official
Owner Agent
Remarks
Service Restored
File details come from the government source that posted it. Updated .