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Home My WebLink About2017-08-04 Backflow Preventor (RPZ) Test Reports - NAC Mechanical 09/17/2017 THU 10: 09 FAX 2002/004 (---( ® , 0 f 1,„,,a0lcal 3 Clumfcsi 50rviccs ., .:4.•a „rnP sir 'oa, a.l:. ' 'r ri.., . BACKFLOW PREVENTER TEST REPORT JOB ADDRESS(INCLUDE ADDRESS p,STREET NAME,&DIRECTIONAL),Apt/Unit 4 I [91 ' 7 OA pa,k, D[ o On -Iel&1At$ BACKFLOW ASSEMBLY INFORMATION (All Fields are Required) System Served: 1--1,&, f t '�- Manufacturer of Assembly: 1A/ (-O Model p ` 1113 Size of Assembly: vv3/ si Serial es d 7 5 L----- T O Location of Assembly: Floor N —i Room 4 /14'C Date test was performed:_ 7 Reduced Pressure Principle Backflow Preventer (RP)—TEST RESULTS Check Valve 42 Shutoff Valve 412 Check Valve 41 Pressure Differential Relief Valve Initial Test Pressure Drop AClosed Tight 14 Yesallo Closed Tight J Yes allo Closed Tight Et/Yes ONo oss Opened at A 11 psid Check Valve 1t1 1• 1 psid Describe parts and I repairs when needed Closed Tight _Yes_No Closed Tight Yes No Closed Tight _Yes No Final Test — —" Pressure Drop Across Opened at psid Check Valve 01 psid Double Check Backflow Prevention Assembly(DC)—TEST RESULTS Check Valve 01 Check Valve 42 Shutoff Valve 412 Closed Tightofes ONo Closed Tight p Yes QNo Closed Tight 0 Yes LINo Initial Test II psid psid Describe parts and i repairs when needed - Closed Tlght=les=No Closed Tight=Yes=No Closed Tight l=YesQNo Final Test psid psid Pressure Vacuum Breaker Assembly(PVB)or Spill Resistant Vacuum Breaker(SRVB)—TEST RESULTS Air Inlet Valve Chock Valve fj Shutoff 42 Failed to Opei=Yes=No ! Closed Tight Q Yes Milo n Initial Test i Pressure Drop Across Closed Tight 1 1 YesIINo Opened at psid Check Valve#1 psid Describe parts and repairs when needed Closed Tight =Yes =No Final Test Opened at psid Pressure Drop Across Closed Tight Yesallo Check Valve#1,.........psid j 1 CERTIFICATION:I certify the foregoingI rmation provided by me to be correct and that the tested suite Is functioning with the limits of the standards. r^Name(Print): /() rkg` Signature: I✓ Date: \(c1 l?. r State of MN Certificate Number: D C[ (7 1 y 08/17/2017 THU 10:09 FAX ®003/004 `(� � .�ch Jnlcpl S E®,I�C1�civ<ca BACKFLOW PREVENTER TEST REPORT JOB ADDRESS(INCLUDE ADDRESS*,STREET NAME,&DIRECTIONAL),Apt/Unit U I 1q-.6e OAJC povk13(vd G ± Pik (�� ti+$ BACKFLOW ASSEMBLY INFORMATION(All Fields are Required) System Served: (r i ��/) Manufacturer of Assembly: klittc Modell# 001 T'1 Size of Assembly: 1/1 Serial U 1 }9 S rh 7 Locatlon of Assembly: Floor It Room I the C Date test was performed Reduced Pressure Principle Backflow Preventer(RP)—TEST RESULTS Check Valve 112 Shutoff Valve#2 Check Valve#1 Pressure Differential Relief Valve Closed Tight Val YesQNo Closed Tlght Yes❑No Closed Tight fp Yes QVo Initial Test Pressure Drop Across Opened at Check Valve#1 1•` psld Describe parts and repairs when needed Closed Tight �Yes_No Closed Tlght Yes No ClosesdTlght _Les_No Flnal Test — — Pressure Drop Across Opened at psid Check Valve11 •,_psid Double Check Backflow Prevention Assembly(DC)—TEST RESULTS Check Valve*1 Check Valve Irl Shutoff Valve ff2 Closed Tight=key=No Closed Tight=Yes qVo Closed Tight 0 Yes IIo Initial Test psid psid Describe parts and repairs when needed Closed Tight`lfes gNo Closed Tight LJ Yes=No Final Test Closed Tight CZI (] Yes No psid psid Pressure Vacuum Breaker Assembly(PVB)or Spill Resistant Vacuum Breaker(SRVB)—TEST RESULTS Air Inlet Valve Check Valve Shutoff 112 Failed to Opei1=Ye1No Closed Tight ® Yes Clio Initial Test Pressure Drop Across Closed Tight 1.YesEI,No Opened at psid Check Valve#1 psid Describe parts end repairs when needed Closed Tight Qles J;;;Jo I� F'� Final Test Opened at psid Pressure Drop Across Closed Tight i IYesIJ,No Check Valve*1 paid CERTIFICATION:I certify the foregoing Information provided by me to be correct and that the tested device Is functioning with the limits of Jthe standards. Name(Print): r f l�r k ;Cr(C Signature: Data: State of MN Certificate Number: 01 08/'_7/2017 THU 10: 05 FAX Z004/004 AVr � • r.har.raf S°Iaclrfral Sr!'/iGRD �� C`LJ<1 BACKFLOW PREVENTER TEST REPORT JOB ADDRESS(INCLUDE ADDRESS#,STREET NAME,.&DIRECTIONAL),Apt/Unit# f BACKFLOW ASSEMBLY INFORMATION(All Fields are Required) System Served: I4 y_Prt4l Manufacturer of Assembly; 1 I Model Is 0 01 Fl ft Site of Assembly: I Serial# -3 1 7 7 cf-5.- / f 7 Location of Assembly: Floor# — Room# J 4 C Date test was performed: '((�t Reduced Pressure Principle Backflow Preventer(RP)—TEST RESULTS Check Valve IP Shutoff Valve U2 Check Valve#1 Pressure Differential Relief Valve C osed Tight YesONo Closed Tight 41 Yes EiNe Closed Tight Yes®Jo Initial Test Pressure Drop Acro,s Opened at e psid Check Valve#1 1 psid Describe parts and repairs when needed Closed Tight _Yes_Na 1 Closed Tight _Yes_No Closed Tight _Yes_No Final Test Pressure Drop Across I Opened at psid I Check Valve#1 psid Double Check Backflow Prevention Assembly(DC)—TEST RESULTS Check Valve#1 Check Valve#2 Shutoff Valve#2 Closed Tight C---Nes=No Closed Tight ®Yes=No Initial Test Closed Tight Yes 11No psid psicl Describe parts and repairs when needed Closed Tlghta►es=Vo Closed Tight I=Yes=No Closed Tight I=1 Yes I=No Final Test psid, psid ) J Pressure Vacuum Breaker Assembly(PVB) or Spill Resistant Vacuum Breaker(SRVB)—TEST RESULTS Air inlet Valve Check Valve Shutoff#2 Failed to Ope=/Ye=No Closed Tight Yes 1=30 Initial Test Pressure Drop Across Closed Tight r1 Yesfl No Opened at •sld Check Valve#1 .sld Describe parts and repairs when needed Closed Tight l=fes =No Closed Tight Yes�No Final Test Opened at psid Pressure Drop Across Check Valve# psid CERTIFICATION: c tlfy trheff regoing rmatlon provided by me to be correct and that t ested device Is functioning with the limits of the standards. Name(Prints: Uy \/ (7)r irc4 Signature: G' ( Date: 3 C /J State of MN Certificate Number: 0 J 0/ Gj 08/17/2017 THU 10: 08 FAX 8001/004 ArAk irk morma�tellallIMMIN r - CHS 1:::, IIIMPR Combustion Heat&Power Mechanical&Electrical Services A Division of NAC 1001 Labore Industrial Court,Sulle 8 Vadnal9 Heights, Minnesota 55110 tel: 651.490.9866 fax 651-490.1636 FACSIMILE TRANSMITTAL SHEET "1'O: FROM: JULIE PAULA IACKSON FAX NUMBER: 651-439-0574 DATE: 8/17/17 COMPANY: TOTAL NO. OF PAGES INCLUDING City of Oak Park Heights COVER 4 PHONE NUMBER: JOB NAME: / JOB NUMBER: 220464 RE: EMAIL ADDRESS: RPZ TEST REPORTS PJACKSON@NAC-HVAC.COM ❑UIIGEN'l' 0 FOR til:vlh;w 0 NL.kAtilt COMMt?Nt' 0 1'l.liASl,: !WPM' 0 t>l,MSnSI Ri'CYCLL NOTES/COMMENTS: