HomeMy WebLinkAbout2021 Interstate Testing RBA Reports Aug.18.2021 10:95 AM Interstate Testing 7637555365 #9520 P 12/21
interstate Testing,LLC.
P.O.Box 5S Backflow AssemblyTest.1 esst. Repo
Anoka,MN 55303 (RPZ,DCVA,PVB,SPVB,)
(163)744-61:49
interstatetestingtkotncast.ftet CitY:
Property/Owner Information. .
Proper Name: Presbyterian Homes (Boutwell Landing
property Address*: addressor
5600 Norwich Parkway
City State Zip:
_Oak Park Heights MN 55082
Ptvpperty.Contact/Phenol.:• Nana:. .. . Phone:
Mike Mader 651 275-5012
Property Dames Address Addrossl
5600 Norwich Parkway Oak Park Heights, MN 55082
City: States Zlp,
Oak Park Hel.hts MN 55082
Property Owner/Phone:#: wee: . . . phone:
Presbyterian HomesiBoutwell Landln9)_ (65U 275-5012
T e of Assembl /Work Performed
R
"Pest .,X R' ' •Ir.,. .,. RB:..,.... est.....: Re.+ir . .RRTest,...._..Re' . r........R5 _......._ Test,,,,,._R , it RB -.�..
Backflow Assembly Information
Size:
1" Wilkins 975XL 1327583 Pool Fill
Location of Assembly: Poo i I room
Backflow Assembly Test Results
Type of Check Valve#1 Shut 0BYalve#2 Relief Valve/ Check Valve#2
Assembly , Air inretvaive
RP,Z•. Open Closed X Open . cjoaed X Opened at 39 old Open closed
P.r+essutapig: 19.0 pst4, Did notopep�..,.,
DCVA °p°"'-rt-- C10 ed Open Gaud OpenClosed.
Presume:W tt. paid Pressure 01(R __pssd
p `
PvB'spvB` Open a*sed Opened at ,psid
Open - Clonal ,__
Pieasureolt/ paid Did not open
Comments:
PASS.. . X; PAIL ;
Tester's Information
Teeter:sa Name, Tester's Signature: Certification#:. Date:
Donn Miller BF065323 08-17-21
Aug.18.2021 10:97 AM Interstate Testing 7637555365 #9520 P 16/21
Interstate Testing,LLC. Backflow O.Bax SS Backflow Assembly Test Report
Anoka,MN 55343 (RPZ,DCVA,PVB,SPVB,)
(763)'744.6149
lnzerStatetesti ng icomcastnet City:
Property./Owner information
Poverty Name: , Presbyterian Homes jBoutwell Landing
Praperty.Addrew. Nicking
5600 Norwich Parkwa
Oty: States zip:
Oak Park Nei•hts 55082
Proper ►Contact jPbane$t Name: ahem:
Mike Mader 651 275-5012
Property.Owners'Address•: Address;
6Q0 Norwich Parkway Oak Park Heights, MN 55082
CtLT. Zip:
,: Oak Park Heights MN . 55082
Property.oWaer/Phone#t Horne: . . PhaueI
• Presbyterian Homes jBoutwell Landlnl (651)275=5012
e Of Assembl jVVo k Performed
Pint • .. ..SPV03, DCVA
est IR Cllr RO T It Air RB Test Re Ir.. RB Test�C .Repair RR
Backflow Assembly Information
Sites Make Model:. Serf$i s Systeeint Serviced
1" Wilkins 950XLT \ 2989315 Washing Machine Fill
Loc.etloa of Assembly:laundry oom, BehindWashing Machines
.
BaOktlow Assembly Test Results
Typeof. Ched&Valve#i Shut Off Valve t2 Relief Valve j. Check Valve#2
Assembly Air Inlet Valve ..
Rpz Open Closed Open Closed Opened at psld Open Closed
Pressure Def. pled Did not open
®CVA Open. Closed X Open Cbsed;,.4..,,, Open Closed X
Pressure DIME 212 paid ..Pressure Dllk 1.8 paid
'Fina/SPVB Open Closed Opened qt . , paid
Open Closed
Pressure L111L paid >Dld not open
Comments:
PASS FAD:: ,
Tester's Information
Testelo Name; Teateria Stguatuie Certification#: Date:
Donn Miller BF065323 08-17-21
Aug.18.2021 10:48 AM Interstate Testing 7637555365 #9520 P 17/21
InterstateTesttng,LLC
Box S5 lBackflow Assembly Test Report
Anoka,MN 55303 (RPZ,.DCVA,PVB,SPVB.)
(763)744-6149
Interstatetesttng4+romcastnet . CitY:
Prop erty/O+wnier Xnformation
P.r`opKy;Name; Presbyterian Homes jBoutwell Landin31
pioiper jl.Adfltr : `; Adam= .
ti 3
5600 Norwich Parkway
Otyr State ZVpt
Oak Park Hei•hts 55082
Prope4ty..Contact/Rbofe#F Ito" . . . phone;
Mike Mader 651 275-5012
Ptpetty Owners Addt'tssi Addire�sr
5600 Norwich Parkway Oak Park Heights, MN 55082
atp state Zip
Oak Park Heights MN 55082
Pcop►r'tt.Oivnef/l Ae5# phones »....�..
Pres Brian Homes Boutweil Landin 651 275-5012
Type.of Assembly/Work•Performed
RPx PYBSPVS DCPA.
estRe it R@ . Testm. Re Air RB Test lr Re Test X,Re tr RB
Backfow Assembly Information
Sinn ,Make: Modelr
Serlal 1T:.. ♦ .. .: .System Seroked. ..
1" Wilkins 950XLT 2989358 Washin• Machine Fill
LocadonooAssembty: Laun•ry oom, .e in. was ing mac mes
gacktIow Assembly Test Results
Type of Che*Valve.#1 • Shut Off:Valve#2 $elteiVa ve/. Check Valve#2
Assemri Y. A irInle ;Valy
RPZ Open- Oosed Open Closed. Opened at paid Open - Chosod
Pressure DilL paid phi tot("to,
DCPA Open Uosod_X•-., Open Closed X Open Closed X_
Pressure DIQ. 2.4 part! PrentureoG 2.4 paid
PVB/SPV0 Open aosed Optiied at. . , paha
Opal.,—._.- Closed
Pressure On , . ,, pstd Old rwtope►t_-.,-_,._-_
Comments«
PASS c.,PAIL
Tester's Information
tester's roe: Tester's Somme:. Certificatton;>R: Date:
Donn Miller BF065323 08-17-21
i