Cross Connection - Submitting Reports

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The City of Olympia has established information that must be provided on the test report form for all tests performed in the City.

Test report forms are the forms that Backflow Assembly Testers use when they test a backflow assembly. To assist testers in ensuring that their forms will be accepted, information has been provided below.

Form options:

Standardized form:

 A printer friendly standardized test report form is available from the City of Olympia. The form is provided in a format that will help ensure that you provide all of the required information.

Use your own form:

 Testers may use their own form or the standardized form available from the City. If testers elect to use their own form, it must contain all of the information listed below:

  • Forms must contain the required information
  • Submit forms within five business days of test
  • Complete forms in ink; submit original copies only (no carbon copies).
  • Forms can be faxed to meet the five day deadline and originals placed in the mail as soon as possible.
  • Forms must be accurate, complete and legible.

Failure to provide the required information will result in test reports being denied.

Backflow assembly test guidelines:

 In order to test within the City of Olympia, State Certified Backflow Assembly Testers must show proof of and maintain the following required documentation:

  • Current Washington State Backflow Assembly Tester (BAT) certification.
  • Current City of Olympia business license.
  • Current verification of gauge accuracy.

What you must do:

  • All test report forms must be submitted to the City Cross Connection Program within five days of completion.
  • Test report forms must be completed in ink; original copies only (no carbon copies).
  • Test report forms must be complete, accurate, and legible.
  • Be responsible for quality control and provide City of Olympia customers with accurate test results.
  • Provide the City with a copy of your required documentation.
  • Documentation must be updated yearly; you will be notified by mail when you need to update your information.

We reserve the right to:

 Reject test reports that are not complete and accurate. Submittal of inaccurate test reports may result in denial of report forms and/or a requirement to retest the backflow assembly. We reserve the right to randomly check test results submitted.

Questions about cross connection? Contact Steve Coke, City of Olympia, Public Works Department, at 360.753.8161, or send an scoke@ci.olympia.wa.us.

Need a permit? Contact the City of Olympia Community Planning and Development Department, at 360.753.8314, or send an cpdinfo@ci.olympia.wa.us.

Need related water quality information? Contact the Public Works office.

  • Physical Address: 924 7th Ave. SE, Suite A
  • Mailing Address: PO Box 1967, Olympia, WA 98507
  • Download printer-friendly (PDF) directions to our office
  • Hours: Monday - Friday from 8:00 a.m. to 5:00 p.m.
  • Phone: 360.753.8588
  • Email: Public Works