Requirements for Roswell Water Utility Approved Backflow Tester

Requirements for Roswell Water Utility Approved Backflow Tester List
(Effective January 1, 2013)
Roswell Water Utility, in an effort to ensure compliance with local, state, and federal
requirements in the protection of the public drinking water supply and to ensure that
accurate data is being submitted for the installation and testing of backflow prevention
devices, will require the following information, listed below, to be submitted to the
Roswell Water Utility.
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Contact Information (Name, Company, Address, Phone, Fax, and email, available)
Company Business License
Company Liability Insurance
Current Backflow Prevention Assembly Tester Certification
Current Test Kit Calibration Documentation
All forms, submitted, must be complete and accurate. The reports shall be legible and
must have a legible & original signature. (Forms may be electronically submitted but the
original, signed, form shall be mailed to the Roswell Water Utility.
Any data not obtainable must be noted in comment box (i.e. meter number not legible,
serial number missing, etc…)
PSI readings shall be recorded for all check valve closings and opening points for RPZ’s.
All test forms must be submitted within 30 days of testing, no exceptions.
A digital picture must be taken prior to testing and after testing and then submitted to the
Roswell Water Utility attached to the test form.
A data tag, provided by the City of Roswell Water Utility, shall be attached to the device
after testing for future reference
Failure to comply with these requirements will result in test forms being
returned. Testers please sign and attach all requirements and submit to the
Roswell Water Utility to the attention of the Backflow Coordinator.
If you have any questions regarding this matter, please contact the Roswell Water Utility
at 770 641-3707, or email them to BackflowTest@roswellgov.com.
Sincerely,
Chris Boyd
Water Distribution Superintendent
Print Name: _________________________________________________
Signature: ___________________________________________________
Company: ___________________________________________________
Date: _______________________________________________________
CITY OF ROSWELL, PW/ENVIRONMENTAL 38 HILL STREET ROSWELL, GEORGIA 30075 TELEPHONE 770-641-3707