Lakewood Village, TX · Denton County
Backflow Prevention Report
This report records backflow assembly and test information for a certified tester documenting equipment at a Lakewood Village service address.
What this form is
The Backflow Prevention Report records the public water supplier, service address, assembly details, use and location, test results, and any repairs or retest results. It also provides space for gauge information, the testing firm, certified tester details, and the tester’s signature and date. The document does not state when the city requires submission.
Who needs it
A certified tester documenting a backflow prevention assembly at a Lakewood Village service address can use this report.
How to submit it
The report lists the Building Department at 100 Highridge Drive, Lakewood Village, TX 75068, and gives [email protected] as an email contact.
About notarization
This report has no notary block; the certified tester signs and dates the certification section on the form.
How to submit this form
- 1
Download the Report
Download the Backflow Prevention Report PDF.
- 2
Complete the Assembly Details
Enter the supplier, service address, assembly, use, location, and test result details.
- 3
Add Tester Information
Complete the gauge, firm, and certified tester fields, then sign and date the certification section.
- 4
Submit to the City
Use the Building Department contact information listed on the report.
Frequently asked questions
- What information does the Backflow Prevention Report record?
- It records the public water supplier, service address, assembly details, type of use, valve location, test results, gauge information, testing firm, and certified tester details.
- Who completes the Backflow Prevention Report?
- The form includes fields for a certified tester’s information, signature, and date, along with backflow assembly and test details.
- Do I need a notary for the Backflow Prevention Report?
- No. The report has no notary block; the certified tester signs and dates the certification section.
- How do I submit the Backflow Prevention Report?
- The report lists the Building Department at 100 Highridge Drive, Lakewood Village, TX 75068, and provides [email protected] as an email contact.