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FriscoBackflow Solutions2020-11-02T08:29:31-05:00

City of Frisco

Please use this form for all new installs, replacements and newly discovered devices. If you have any questions please call 800-414-4990 or email bsionline@backflow.com.

"*" indicates required fields

Property Address*
Type of property*
Is mailing address the same as the property address?*
Mailing Address*

Backflow Assembly

The backflow prevention assembly detailed below has been tested and maintained by Texas Commission on Environmental Quality (TCEQ) regulations and is to be operating within acceptable parameters.
Please put detailed description of the location. (For example, NE corner of the mechanical room or garage south wall)
Device Condition*
Isolation/Containment*
Device Type*
Assembly Type*
Is the backflow assembly installed in accordance with manufacturer recommendation and or local code?*
Is the backflow assembly being used for*
• Is the assembly installed on a non-potable water supply (auxiliary)?*

Test Information

MM slash DD slash YYYY
Test Time*
:

Check Valve #1

Status*

Check Valve #2

Status*

Relief Valve

Status*

Air Let

Status*

Check Valve

Status*

Initial Test Status*

Retest After Repair

Retest Status
MM slash DD slash YYYY
Test Time
:

Tester Information

Name of Tester*
MM slash DD slash YYYY
Potable/Non-Potable Test Gauge*
MM slash DD slash YYYY

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