Annual Hydrant Inspection and Certification Form

Completed forms are due NO LATER THAN AUGUST 31 of each year

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Mail to: Oakwood Water Department, 30 Park Avenue, Oakwood OH 45419

Hydrant Owner Name:

Telephone No:

Date:

Street Address:

City:

State:

Zip:

Hydrant No.:

Inspection date:

Inspection Contractor/Company name:

Inspection Contractor/Company phone:

INSPECTOR INITIALS	REQUIREMENT	INSPECTOR COMMENTS
	Notify Oakwood Water Department in advance of performing work.
	Visually inspect area adjacent to hydrant for signs of leaks, damage, or other needed maintenance. Ensure proper clearance for accessibility.
	Visually inspect hydrant. Exterior surfaces and finishes should be in good repair and free of cracks or leaks. Any missing hardware should be replaced.
	Remove caps. Clean/lubricate threads and ensure proper function.
	Exercise watch valve(s) to ensure proper function.
	Open hydrant SLOWLY to full-open position, using hose or diffuser as necessary.
	Perform fire flow test, if required. GALLONS PER MINUTE: (NOTE: The fire flow test is only required once every five years. It is NOT an annual requirement).
	Check for leakage.
	Reduce flow and run for 3 minutes or until clear, whichever is longer.
	Reduce flow SLOWLY and shut off hydrant.
	Ensure that hydrant stops dripping. Re-flush if necessary.
	Pump water from barrel of hydrant, if not self-draining.
	Remove hose/fittings; replace caps.
	Repair any damage to surrounding area.

CERTIFICATION: I certify that this fire hydrant has been inspected and maintained as set forth above, and is properly performing within applicable standards and specifications, including but not limited to AWWA M17 and NFPA 291.

Inspector signature:

Date:

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