HomeMy WebLinkAbout2021 Interstate Testing RBA Reports Aug.18.2021 10:90 AM Interstate Testing 7637555365 #9520 P 9/21
Interstate Testing,LLC
P.O.Box SS ° Backflow Assembly Test Report
Anoka,MN 55303 (Rn,DCVA,PVB,.SPVB,j
(763)744.6149
interstatetesting ocouncastnet C1tY:
Pro a /Owner Information
Property Name
Boutwell Landing
property Address: Addles=
5350 Nolan Parkway
lily:
State Zip:
Oak Park Hehts mN 5 5 082
Property Ben d f Phone#: Nam e; Phone
Dean Evanson . 612 503-7498
Pmperty;Owners Address:: Address:
5600 Norwich Parkway Oak Park Heightt MN 55082
City: Statex
Oak Park Hel.hts N . 55082
Propertyahrnet'fP.hone#i• same: phone:
Presbyterian Homes (Boutwell Landin (651)_275-5012
Type of Assembly/Work Performed
RPS PITS * SPV1 DCVA
Test X .Re r RB Test R air RB 3'est Ir Test,_._Re it RS
Backflow Assembly Information
Size: Make: Mcidel: sari i#r Sti.teMServtret.
3/4" Wilkins 975XL 1690655 Garba•e Rinse
Location of •utsi•e garage area, near cep mg
Backtlow Assembly Test Results
Type of Check Vape i Shutoff Valve 02 Rettel Vaive f • ChcckValye#2
,,Assen*b1Y v Air:InletValve . .
an Open ;_ Closed_ Open Closed_ _.,_ Opened et paid Open. Clds+ed
Pr ureDU, 8.8paid Old not open,
DCVA OPon C34sed._:_:.. Open ._ _ Closed__.,_ Open Closed
Pressure DU paid Pressure Diff__,.,__paid
Open Closed Opened at .paid�_,_,._
p"VI f SPYB Open. Closed
Pressler*OM_ paid Did not open
Comments.
'PASS X FAIL...-..r,-:.
Tester's Information
Testes Name: Tester's Signature: Certification:#: : : Dater.
Donn Miller p� BF065323 08-17-21
Aug.18.2021 10:40 AM Interstate Testing 7637555365 #9520 P 3/21
I nteirstateTesting,LLC
i�.Q. SS Backflow Assembly Test Report
Anoka;MN 55303 (RPZ,DCVA,AV.B,SPVB,)
(763)744.6149
Int arstatetesdng@comtast.net City: -
Propertyiowner.Information
•ernpertyNamr:
Boutwell Landin
gmpertyMdr*se: r AAd5350dress:
Nolan Parkwa
Cid State: Zip:
Oak Park Heim hts u k 55082
'P C MPW/Pbon #: Nam*: Phase;
Dean Evenson . 612 503-7498
Property Owners Address:. Address:
• 5600 Norwich Parkway Oak Park Helahts, MN 55082
drys Static .. 71p:
Oak Park Heights MN 55082
Property.owner/PhOae#: Kamm Phone:
Presb terian Homes Boutwell Landin 651 75-5012
Type of Assembl /Work Performed
PVB $ 'KVA
Test X Repair Re 11'sest�._ Reyalr ;¢RB_ . Testi Repair )1t# Test Repot! .. ..RB
Backflow Assembly Information
Sizer • -. .. Makei Models Se +r#: 7 S ate cad.
3/4" Wilkins 975XL 1690660 Boiler Make Up
Location of Assembly: B.S. boiler Room, bulldingl"3 '
Backflow Assembly Test Results
'type of Ciited(Valve#1 Shut Off Valve#2 ftelielVataei Check Valve#2
Assembly _ Mr Inlet Valve
Rpz Open Closed-_ Open Closed Opened at 3.0 psid. .Open , ,-Closed...X
Pressure IMO'. 9.9 old Did not open ,
•
DCVA opcn Closed Open Closed, Open , Closed
Pressure OM old .Pressure DM._ old
AVg/iPVB °pert Closed Opened at psld
Open Closed
Pressure Dllt �_„paid . DW not open_
Comments:
PASS, X FAA.
Tester's Information
Testrerr'sName; ;G'ester*Mitnature; Certiftcation;#: Date:
Donn Miller /' BF065323 08-17-21