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City of Oakwood
Trash pickup for all routes the week of May 26 will be one day later than usual.
Utility Billing
Backflow Prevention
Online Backflow Certification
Online Backflow Certification
Are you submitting a completed pdf or the online form?
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PDF
Online Form
Backflow Certification Form PDF
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Required
Accepted file types: pdf, jpg, gif, png, Max. file size: 25 MB.
Property Owner
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Required
Name
Telephone
DEVICE INFORMATION
Device Address
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Required
Street Address
Device Location
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Required
Device Size
*
Required
Device Make
*
Required
Device Model
*
Required
Device Serial Number
*
Required
Is this a new device or an annual test?
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Required
New Device
Annual Test
Type of Service
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Required
Irrigation
Fire
Type of Protection
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Required
Isolation
Containment
TEST INFORMATION
Initial Test Date
*
Required
MM slash DD slash YYYY
1st Check Valve - Reduce Pressure Assembly
PASS
FAIL
What PSID did the 1st Check Valve - Reduce Pressure Assembly open at?
2nd Check Valve - Reduce Pressure Assembly
PASS
FAIL
What PSID did the 2nd Valve Check - Reduce Pressure Assembly open at?
Relief Valve - Reduce Pressure Assembly
PASS
FAIL
What PSID did the Relief Valve - Reduce Pressure Assembly open at?
Air Inlet - Pressure Vacuum Breaker
PASS
FAIL
What PSID did the Air Inlet open at?
PRESSURE VACUUM BREAKER
Check Valve - Pressure Vacuum Breaker
PASS
FAIL
What PSID did the Check Valve open at?
PRESSURE VACUUM BREAKER
Were repairs needed?
*
Required
Yes
No
After Repairs: 1st Check Valve - Reduce Pressure Assembly
PASS
FAIL
After repairs, what PSID did the 1st Check Valve - Reduce Pressure Assembly open at?
After Repairs: 2nd Check Valve - Reduce Pressure Assembly
PASS
FAIL
After repairs, what PSID did the 2nd Check Valve - Reduce Pressure Assembly open at?
After Repairs: Relief Valve - Reduce Pressure Assembly
PASS
FAIL
After repairs, what PSID did the Relief Valve - Reduce Pressure Assembly open at?
After Repairs: Air Inlet - Pressure Vacuum Breaker
PASS
FAIL
After repairs, what PSID did the Air Inlet open at?
PRESSURE VACUUM BREAKER
After Repairs: Check Valve - Pressure Vacuum Breaker
PASS
FAIL
After repairs, what PSID did the Check Valve hold at?
PRESSURE VACUUM BREAKER
Comments
AUTHORIZATION
TEST PERFORMED BY
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Required
First
Last
PLUMBING COMPANY
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Required
Name
PHONE
*
Required
CERTIFIED TESTER #
*
Required
CERTIFICATION EXPIRATION
*
Required
MM slash DD slash YYYY
By checking the box below, I certify all information on this report is true and accurate, acknowledging that incomplete reports will not be accepted.
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SIGNATURE
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DISCLAIMER: By typing your name above, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.
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