Lancaster, TX · Dallas County
Initial Test and Maintenance Report
Backflow testers complete this report to document an assembly’s initial test and provide the results and device details to the City of Lancaster.
What this form is
Use this report to record an initial backflow assembly test, including assembly and property details, tester information, test results, and any action taken if the assembly failed. The form says to forward the original within five days of the test and include a $25 registration fee for each device. Illegible or incomplete reports will not be accepted.
Who needs it
A backflow tester should complete and forward this report after performing an initial test on an assembly.
How to submit it
Forward the original report within five days of the test to the City of Lancaster, Community Development, 211 N Henry Street, Lancaster, Texas 75146-0940. Include the $25 registration fee for each device.
About notarization
This report is signed and dated without a notary; the tester certifies the information is true and correct, and no sworn attachment is identified.
How to submit this form
- 1
Download The Report
Download the Initial Test and Maintenance Report PDF.
- 2
Complete The Report
Enter tester, firm, assembly, and property details, then record the initial test results and any action taken if the assembly failed.
- 3
Gather The Registration Fee
Include the $25 registration fee for each device, as directed on the form.
- 4
Forward The Original
Send the original to Lancaster Community Development within five days of the test at the address listed on the form.
Frequently asked questions
- Do I need a notary for the Initial Test and Maintenance Report?
- No. The report has tester signature and date fields but no notary block. The tester certifies the information is true and correct.
- How do I submit the Initial Test and Maintenance Report?
- Forward the original to Lancaster Community Development within five days of the test. The form lists 211 N Henry Street, Lancaster, Texas 75146-0940, and a $25 registration fee for each device.
- What information does the report ask for?
- It asks for tester and firm details, backflow assembly and property information, initial test results, and any action taken if the assembly failed.
Need something notarized?
This Initial Test and Maintenance Report doesn’t need a notary — but Texas residents can notarize other documents online with a commissioned online notary.