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Home My WebLink About2019-09-05 Backflow Preventor (RPZ) Test Reports - NAC Mechanical BACKFLOW PREVENTER TEST REPORT JOB ADDRESS(INCLUDE ADDRESS#,STREET NAME,&DIRECTIONAL),Apt/Unit# O je,/k //e/c) is c, hal/ /y/G 4/ pale P AI 0 BACKFLOW ASSEMBLY INFORMATION(All` Fields are Required) System Served: /A-PV—C,11--77/5 Manufacturer of Assembly: Wim•'[ ( � Model# 6(, )1!"/ Size of Assembly: ( � Serial# J / E49 Location of Assembly: Floor# (,✓`1 t/ y G 1 f Room#/1/1''C "` Date test was performed:rj Reduced Pressure Principle Backflow Preventer(RP)—TEST RESULTS Check Valve#2 Shutoff Valve#2 Check Valve#1 Pressure Differential Relief Valve Closed Tight ❑YesDNo Closed Tight Q Yes UNo Closed Tight I=Yes=1Vo Initial Test Pressure Drop Across Opened at psid Check Valve#1 psid Describe parts and repairs when needed ` Closed Tight Nc-Yes No Closed Tight y'Yes No Closed Tight 1-'1'es No C Final Test — Pressure Drop Ako- /ss Opened at 3. / _psid Check Valve#1 25. 2 paid Double Check Backflow Prevention Assembly(DC)—TEST RESULTS Check Valve#1 Check Valve#2 Shutoff Valve#2 Closed Tight' ties ONo Closed Tight =Yes hyo Closed TightEl Yes EINo Initial Test psid psid Describe parts and repairs when needed Closed Tight! Yes=No Closed Tight t'Yes yo Closed Tight D Yes I=No Final Test psid psid Pressure Vacuum Breaker Assembly(PVB)or Spilt Resistant Vacuum Breaker(SRVB)—TEST RESULTS Air Inlet Valve Check Valve Shutoff#2 Failed to Opei_tYe=No Closed Tight Yes no Initial Test Pressure Drop Across Closed Tight Yes No Opened at psid Check Valve#1 psid Describe parts and repairs when needed Closed Tight IKes Colo Closed Tight YesL_No Final Test Opened at psid Pressure Drop Across Check Valve#1 psid CERTIFICATION:I certify the foregoing information provided by me to be correct and that the tested device is functioning with the limits of the standards. Name(Print):TAYLER REICHOW Signature: v.. Date: / State of MN Certificate Number: 07781 9 BACKFLOW PREVENTER TEST REPORT '),cci3b JOB ADDR4vfr INCLUDE ADDRESS#,STREET NAME,&DIRECTIONAL),Apt/Unit# �X 1)4 I, c i A 1/ /4//6",S- cif otlk A A' 6/v/11/ BACKFLOW ASSEMBLY INFORMATION(All Fields are Required) System Served: /r/7 601-110 n Manufacturer of Assembly: !^-'O(}/1-:_..0 Model# 0 0 9 o"'7 .2-, / ) 2- )r Size of Assembly: [ Serial# 3 C/ S Location of Assembly: Floor# f t/-*-1 it," /+`l c1 :'--,s Room# /�',c,A Date test was performed:9-S ( 9 Reduced Pressure Principle Backflow Preventer(RP)—TEST RESULTS Check Valve#2 Shutoff Valve#2 Check Valve#1 Pressure Differential Relief Valve Closed Tight (=Yes=r\lo Initial Test Closed Tight 0 Yes No Closed Tight Q Yes IINo Pressure Drop Across Opened at psid Check Valve#1 psid Describe parts and repairs when needed Closed Tight Yes No Closed Tight `\-'Y"es No Closed Tight Yes No Final Test ' - Pressure Drop Across Opened at /.2psid Check Valve#1 '7r Ypsid Double Check Backflow Prevention Assembly(DC)—TEST RESULTS Check Valve#1 Check Valve#2 Shutoff Valve#2 Closed Tight=Yes=:1No Closed Tight n Yes=iVo �`'-� Initial Test Closed Tight l l Yes ENo I psid psid_ Describe parts and repairs when needed Closed Tightt'es ONo Closed Tight Yes 1:::-'4o Closed Tight CI Yes IINo Final Test psid psid . Pressure Vacuum Breaker Assembly(PVB)or Spill Resistant Vacuum Breaker(SRVB)—TEST RESULTS Air Inlet Valve Check Valve Shutoff#2 Failed to Ope Ye l No Closed Tight 0 Yes Filo Closed Tight Yell No Initial Test Pressure Drop Across Opened at psid Check Valve#1 psid Describe parts and repairs when needed Closed Tight fifes QJo Closed Tight a YesE_No Final Test Opened at psid Pressure Drop Across Check Valve#1 psid ' CERTIFICATION:I certify the foregoing information provided by me to be correct and that the tested device is functioning with the limits of the standards. Name(Print):TAYLER REICHOW Signature: �--_ Date: /—C`/ C) State of MN Certificate Number: 07781 9 BACKFLOW PREVENTER TEST REPORT 2,5-S-/ 30 JOB ADDRESS(INCLUDE ADDRESS#,STREET NAME,&DIRECTIONAL),Apt/Unit# i {//`c iyArl /AU /Y/(5' oak ',9f BACKFLOW ASSEMBLY INFORMATION(All Fields are Required) System Served: I ��C0C19 Manufacturer of Assembly: / JModel# Size of Assembly: % Serial# 2 /73-5 e/6 o, Location of Assembly: Floor# ~/ Room# (C h Date test was performed: Reduced Pressure Principle Backflow Preventer(RP)—TEST RESULTS Check Valve#2 Shutoff Valve#2 Check Valve#1 Pressure Differential Relief Valve Closed Tight ❑YesDNo Closed Tight Q Yes UNo Closed Tight Yes QJo Initial Test Pressure Drop Across Opened at psid Check Valve#1 psid Describe parts and repairs when needed Closed Tight-re's_No Closed Tight .).--Yes No Closed Tight '�Yes No f'� Final Test —' Pressure Drop Auss Opened at Pr psid Check Valve#1 Li O psid Double Check Backflow Prevention Assembly(DC)—TEST RESULTS Check Valve#1 Check Valve#2 Shutoff Valve#2 Closed Tight' _Xes ONo Closed Tight I=Yes t—.lo Closed Tight E Yes E1No Initial Test psid psid Describe parts and repairs when needed Closed Tight=ties=No Closed Tight�_Yes=No Final Test Closed Tight I-1 Yes=No psid psid Pressure Vacuum Breaker Assembly(PVB)or Spill Resistant Vacuum Breaker(SRVB)—TEST RESULTS Air Inlet Valve Check Valve Shutoff#2 Failed to Opeia__lYeI No Closed Tight D Yes Flo Closed Tight n Yesallo Initial Test Pressure Drop Across Opened at psid Check Valve#1 psid Describe parts and repairs when needed Closed Tight 1=r es I=No Closed Tight D.Yest:1No Final Test Opened at psid Pressure Drop Across Check Valve#1 psid CERTIFICATION:I certify the foregoing information provided by me to be correct and that the tested device is functioning with the limits of the standards. Name(Print):TAYLER REICHOW signature: „fp,— Date: --c-'79 State of MN Certificate Number: 077819