Group_V:_Annual_Inspection_Backflow_Preventer_Report_SAMPLE.pdf

This document is a Backflow Preventer Report for a water meter assembly located in Homestead, Florida, dated 4-1-25. The report documents a test of a Watts brand backflow preventer (Model #007-M-QT) with an inlet line pressure of 45 PSI. The test was conducted on a DC (Detector Check) type assembly, with the location specified as "on meter by pass fire line". The Fire System Bypass Water Meter Reading was 001304, and the bypass isolation valves were in the OPEN position.

The report indicates that the backflow preventer passed inspection with no deficiencies noted. Specific details of the test show that Check Valve #1 had a differential pressure of 1.1 PSI across the check valve, while Check Valve #2 had a 2.0 PSI differential pressure. The Pressure Vacuum Breaker was not fully tested. The certified tester's certificate expires on 12-5-26, and the report was received on 4-1-25. All repairs must be completed within ten days of the test, as noted in the document's standard instructions.