HomeMy WebLinkAbout2021 Interstate Testing RBA Reports Aug.19.2021 10:92 AM Interstate Testing 7637555365 #9520 P 7/21
Interstate Testing,LLC
P.O.Box 5S Backflow Assembly Test Report
Anoka,MN 55303 (RPZ,DCVA).PVB,SFV&,)
(763)744-6149
interstatetesttng@cotgcast.net City:
Property/Owner Information
Boutwell Landing
PrapertY.A4di : . . 545aadtes
0 Nolan Parkwa .
city: state: Zlpi
Oak Park Heights ttN . 55082
Property Canta*t/Phlonetlt Name: Phone:
Dean Evenson 612 503-7498
Prapelrty 0WneN Address:, Address
. 5600 Norwich Parkway Oak Park HeightsMN 55082
City:. States Zip:
_Oak Park_Hel9hts MN 55082
POoixt ty Owner/Phoae:# Name: Phone:.
Presbyterian Homes (Boutwell Landing) . . (651)Z75-5012
Type of Assembly/Work Performed
RPZ . Ova SPV B DCVA
Tom,X Repair RB,„„„,,, Test o.,.,Repair .�. RB , . Tese.....,Repair RB .., Test_Repair RB
Backflow Assembly Information
Size Make: iriodel: - Serial#t 1 : '.m • ee&
3/4" Wilkins 975XL 1690679 Chiller Feed
Location of Assembly; IABA bolding, Boiler Room
Backflow Assembly Test Results
Type of Check Valva#3 Shin Ott:Valve tl2 ReiiefValve/ Cheek Valve.#2
Ass4tnbly Air.Iniat:Valve
Ttpz Open Closed Opal Closed X Opened al 3,0 pad Open Mae* X
Pressure DM 9.4 paid. Did Cat open
11CVA, Open Clewed Open .Closed Open .Closed:
Pressure DIM--- paid Pressure Dift. paid
PVB/SP11$: Open,,,,,,_,,; nosed opened at ..,,;,,paid
Open ..» awed
Pressure Dt f paid Did not open--
.
Comments:
:PASS X *PAX
Tester's Information
Tester's Name. Tester's Stgturc: CVrtifcadon.#: Date
Donn Miller 0!/-v .
BF065323 08-17-21
1
Aug.18.2021 10:91 AM Interstate Testing 7637555365 #9520 P 6/21
Interstate Testing,LLC
P.O.Box 5S Backflow Assembly Test Report
Anoka,MN.55303 (RPZ,DCVA,PVB,SP'VB,)
(763)1446149
interstatetesttnggcomcastnet Ci ° _
Propel/Owner I l formation
Names - - . ' . _. - ,.: ,
p,
Y Boutwell Landing
property Address: Addrespic
. . 5450 Nolan Parkwa
• Clt7: State: Zlp:
Oak Park Hel•hts 5508
Pe re iy Contact/phone#: Na Pboaea
Dean Evenson . . (612)503-7498
Property:Ownerd,Address: .Address: .
5600 Norwich Parkwa Oak Park Heights, N 55082
City: Stoic . .. Zip:
Oak Park Hel•hts 4 55082
Property:Owner/Phone#c ... Name: Mile:Presbyterian Homes Boutwell Landin 651 275-5012
Type of Assembly/Work Performed
RP4 ..."Art .: .: ..ASPVD ` '.' .KO '.
Test X Repair RB Test Repair RB,_., Test_Repair: .RB, .Test,,,,,,,._Repair RB
Backflow Assembler Information
size Make; • Model: : ViYrYYYiIY�Serial#:.� YII . m
Iri++r+Y _ �.. .�-T•lt� .
314" Wilkins 975XL 1690666 Boiler Make Up
Location of Assembly: �S�A bui ding,Boiler Room
Backflow Assembly Test Results
7ype:ot Check Valve#1. Shut Off Valve#2
Relief Valve/ t31e�V'att;e#2
Assembler , : rA,ir Welt.Valve
RPZ OPen Closed---X-- open ,� ciosed,r,L.. Opened at $4 psid Open Closed X
• Pressure Ott 9.0 psid. Did not open
Opea,,,,,,„,_ CloyedOpen Closet)
ACVA Open Closed
Pressure 010. paid Pressure DNC . psid
k r .4
PVB/SFVs Open-- Closed Opened at psid
Open Closed
Pressure D1it. „ ;psid Old not open
Comments: >.
d'ASS._)(_PAIL . , +`
Tester's Information
Tester's Name: Testes Signature: Certification#: Date:
Donn Miller • pi+ BF065323 08-17-21
1
Aug.18.2021 10:43 AM Interstate Testing 7637555365 #9520 P 8/21
Interstate Testing,LLC
P.O.Box SS Bac ow Assembly Test.Report
Anoka,MN 55303 (R.P2,DCVA,PVB,SPVB,)
(763)7444.1.49
intersiatetesttngecotacastnet City:
Property/Owner Information
per Name.
Boutwell Landin•
Property.A,ddi!essc Addy+
• . 5450 Nolan Parkwa
City: State: Zip:
Oak Park Hei.hts 141. . 55082 ..
Pl frpetty contact/Phone# Name; ' Phone:
Dean Evenson 612 503-7498
property Owners Addt'ew . mortis:,
5600 Norwich Parkway Oak Park Heights MN 55082
city: State Zip:
Oak Park Hei hts MN 55082
p
Proertk OwnerIPhQne#• Name; ?hone
Presbyterian Homes iBoutwell Landinn 5651)275-5012
T e of Assembl Work Performed
RPS P.VB YR KVA
TeSC X R it RB T t #te Ir RBTaal R r. RH et ,.....R dr RS
Backflow Assembly Information
Siwe: Make: Model: Serial it::: System Serviced:
3/4°° Wilkins 975XL W121089 Garba•e Rinse
Location of Assembly: = =w •ing, garage room
Raclflow Assembly Test Results
'type of CheckValve#1 Shut Off Valve#2 BalledVatve/ CheckYalve#2
A'. nth Air inlet Valve
R,Z Open. Closed X Open . nosed X Opened at 2.8 psad Open_ _ _ aoscd X
Pressure DIM.. 8,4 .paid Dad not open_ .
DCVA aptn Closed Open Closed Open Gosed
PressureDUJ ps1d Pumas DIM paid
PVB/SPVB OPen Closed Opened at . paid
Open Closed
?courant DIM paid Dld not open
Commends:
PASS X `FAIL..-.�..,
Tester's Information
Tester Nance: 'Tester's Sig 4ature: • .CerdficaNQn#g Date:
Donn Miller . -� / 1/V BF065323 08-17-21