Doh 1013 Form PDF Details

Ensuring the safety and quality of public water supplies is a critical responsibility that involves regular testing and maintenance of backflow prevention devices. In New York State, this responsibility is underscored through the use of the DOH 1013 form, a comprehensive document mandated by the New York State Department of Health Bureau of Public Water Supply Protection. This form serves as a detailed report on the testing and maintenance activities carried out on backflow prevention devices, which are essential in preventing the reverse flow of water from potentially contaminating the public water supply. The form is structured into two main parts: Part A, which must be completed by a certified tester for both initial and annual tests, detailing the device's location, specifications, testing results before and after repairs, and final certification of the device's compliance. Part B is reserved for the design engineer, architect, or water supplier for initial tests, providing certification that the installation matches the approved plans. The document also includes sections for detailing deficiencies, making repairs, and certifying the accuracy of the provided information. By requiring the completion and submission of the DOH 1013 form, the New York State Department of Health ensures that each backflow prevention device is functioning correctly, protecting the community's health and safety by maintaining the purity of its water supply.

QuestionAnswer
Form NameDoh 1013 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesnys doh 1013 form, doh form 1013, doh 1013 test and maintenance form, doh 1013 pdf

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1. Fill out your doh 1013 pdf with a group of major fields. Collect all of the information you need and make sure absolutely nothing is left out!

Part number 1 in filling in form 1013 doh

2. Once your current task is complete, take the next step – fill out all of these fields - Describe repairs and materials used, Repaired by, Name, Lic, Date repaired M D Y Date, M D Y, Final test, Closed tight, Closed tight, Opened at psid, Pressure drop across first check, Water Meter Number, Meter Reading, Type of Service check one, and Remarks Describe deficiencies with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

The right way to complete form 1013 doh portion 2

3. In this specific stage, have a look at Property owners or owners agent, PART B, Certification that installation is, To be completed by the design, I hereby certify that this, Name, License Number, Representing, Address, City, Title, Phone, Date, m d y, and Describe minor installation changes. Each of these will need to be filled out with utmost precision.

form 1013 doh conclusion process detailed (part 3)

You can certainly make a mistake when completing the License Number, for that reason ensure that you reread it before you'll finalize the form.

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