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HomeMy WebLinkAbout2021 Interstate Testing RBA Reports Aug.18.2021 10:44 AM Interstate Testing 7637555365 #9520 P 11/21 tinterstate'resting,tLC P.O.Box SS Backflow Assembly Test Report Anoka.MN 55303 . (BPZ,DCVA,PVB,SPVB,) (763)744-6149 fnterstatetesting@corncast:net C1tY Property/Owner Information , Property Nome: Presbyterian Homes(Boutweli Landing) - : . Acddxe prrl .pr►Addres�i; ;. : . 5 Norwich,Parkwa f C1tra State: Zlpi Oak ParkHei•hts ai .. 08 Property Contact/Phone#: Naa+e: Phone! Mike.Mader (651)275-5012 Property Owners Address: Addrerc • 5600 Norwich ParkwayOak Park Hei h MN 55082 City: Stair. Zip: Oak Park Heights MN 55082 Prdperty Owner p heni:#: Name:. Phone: . Presb .erian Homes Boutweli Landin 651 275-5 12 Type of Assembly/Work Performed RPZPVS SPVB ocv.. est.,,.X. R' 'air RB .... T st it• w r._..._..RB _.-.. Test _. R:,-•r .....: RB _ Test Repair RB Backflow Assembl tnfarmatlon Sine: MaksModel: Serial S Serviced: 3/4" Wilkins 975XL 1293783 Boiler Make Up Location of Assembly; I. . =o er room Backflow Assembly Test Results Type of Check Valv►e;01 Shut 011VAtve#2 goer Valve/ Chock Valve#2 Assembi AirInlet Valve fin Open,,._,,,,- Closed , x,,- Open Closed ._ Opened at 2�8 psld Open Gonad _C PressureDift. 9,2 paid Did not open OPen,- Closed Open Closed Open Close Pressure.nift Paid Pressure DIM psld Pveifsp frB Open Cloned Opened at paid Open Closed PcsasureD1ff. paid. Did not open Comments: PASS 1t Tester's Information Tester's Name: .1 ester`s Signature:.: Certification# Pate: Donn Miller • Ing+ BF065323 08-17-21 Aug.18.2021 10:43 AM Interstate Testing 7637555365 #9520 P 9/21 Interstate Testing,laLC <o..6ox55 ` Backflow Assembly Test. Report Anoka,MN 55303 (RPZ,DCVA,PVB,SPVB,) (763)744.6149 Interstatttesting@comcastnet. City: Property/.Owner information. . Property Name: Presb erian Homes Boutwell Landin• Property Adtiresst A dne _� 5.s• Norwich Parkwa . !� 1 State: ZIp: Oak Park Heil.hts . . 41,, 0:2 Property.:contact/Phone#: Name: phone: Mike Mader 651 275-5012 Party Owners Addkest Address., 5600 Norwich Parkway Oak Park Heights, MN 55Q82 CityStatet Zip: Oak Park Hei•hts MN 55082 Proper'tY OMner/Pb0ne#t Name: Phoma: Presb erian Homes Boutwell Landln. 6 1 275-5012 Type of Assembly(Work Performed. RPZ PVB :. Sly. DCVA Test,X Rep.sir,RB Test,Repair RB Test Repair., RB . _ Test_Re afrRBS Backflow Assembly Informations Size:. Makes Model:;. Serial:#::. S zn erviced 314" . Wilkins 975XL . 1298714 Location of Assembly: i..L.gash Rm. Backflow Assembly Test Results Type of Check Valve#.2° ShutOff Valve#2 RReitefWillie/ Check Valve##2 Anemia Air Inlet Valve RPZ open eiosed,-_ Open_ _. __ closed X opened at 3,5 psd Open__.. closed X Pismire Diff: 99;6 psid Old net epen ' • ... f . DCVA Open Closed Open Closed , Open dosed Pressure.OH! paid Pressure DOC .___- paid PVB/Siena °pen Closed Operscdat .psid Opere Glossa_.— Prel*Ar4 Di rt. Pdci Did not open Comments: PASS Tester's Information Tester's Name Tester's Signature: • Certification.* Dare Donn Miller !" Q� BF065323 08-17-21 Aug.18.2021 10:99 AM Interstate Testing 7637555365 #9520 P 10/21 inte,>rrstate Testing,fad P.O.Box 55 Backflow Assembly Test Report Anoka,MN 55303 (RPZ,DCVA,PVR,.SPVB,) (763)744-6149 interstutetesdng@cont astnet. ItY: _ Property/Owner Information. Presbyterian Homes_poutwell Landu, Prapart7Address: Addrete • 56U'6 Norwich Parkwa ,5690 • tiltyi State: Zip: Oak Park Heights MN 55082 Property Contact/Phone t: Nome' Phene; Mike Mader (651)275-5012 ............� iPt ltyowne�rs Address:. 4tfrf 5600 Norwich Parkwa Oak Park Hai.hts MN 55082 City: SFate Zip: Oak Park Heights MN 55082 Property Owner/phone.#: Mine: . Phone: Presbyterian Homes(Boutwell Landing) (651)275-5012 Tyye.of Assembly/Work Performed • pvs .. . pvn ' DCVA Test X Repair RB Test iteealr „RBTen esReJ'$r ,,,RB „r _ Test r.,_Ae air.w.,,.r,RP Backflow Assembly Information Sizes Make Model::. Serfal# .: :: ; Sym Serviced: 3/4" . . Wilkins 975XL 1298744 Location of Assembly: I.L. ar.ag e 'm. Backflow Assembly Test Results Type.of "Check Valve#1 Shut Off Valve t#2' Relief.Valve/ Check Valve#2 Assembly`: .Air.inlet.Valve fin Open. Closed.X Open ©oeed X Opened of 3.6 paid Open Closed X Pressure'PM, 8.4 paid .MAIM open. „. DCVA °pe°— awed Open Closed Open Closed Pressure um. _ paid ' Pressure psid PVDJVI : Open Cloned Opened at .paid Open .Closed Pressure Otft.. paid Did not open Comments: PASS_ pAll:: Tester's Information Tate*Name: Tester's.Signature:: • Cerrtiftcadon.#: Pate Donn Miller a BF065323 08-17-21