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10/11/2021 Backflow preventer test
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0875 Wayzata Blvd W - 35-118-23-44-0011
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10/11/2021 Backflow preventer test
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Last modified
8/22/2023 4:59:54 PM
Creation date
11/4/2021 4:16:14 PM
Metadata
Fields
Template:
Address
House Number
875
Street Name
Wayzata
Street Type
Boulevard
Street Direction
West
Address
875 Wayzata Boulevard West
Document Type
Misc
PIN
3511823440011
Supplemental fields
ProcessedPID
Updated
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r <br />Modef it se let# 3 5'ta`31/ -3/-, <br />System ServieedL X01 c E>Z ic.c �f She:, _ (Inches} <br />mechanical, <br />contractorsInc, <br />1257 Marschall Road, P0, Box 237 • Shakopee, MN 85379 <br />Phone;•852/445.5100 <br />Cheek Valva k2 Shutoff Valve N2 Check Valve #11 -FR <br />ressure Differential <br />Pax: 9521415.5119 <br />iVAMEOP 13UILOING, aWNFR/OCCUPANT� CONTACT NAME AND PHONE NUMBER <br />l r<�ai�5 or <br />ClosedTight ,..._Yes—No <br />COMPLETE JOB ADDRESS (INCLUDE Apt/Unit #) <br />Closed 7TIght—Yes ,._.-NoTest <br />APPLICANT CpMPANY NAME <br />pressurss Che;Vatve #1 Opened at psid <br />._.._psid <br />CONTRACTOR LICENSE tI •CONTACTM1JANIE AND PHNI NUiNBt fi <br />Associated Mecharoicai C®r�tractars L098 22749 <br />ADDRESS CITY <br />,Charlie R(echer's 952-495:530U <br />Pa Box a37 Shakopee <br />TESTEf; NAME... <br />STATE Zip EMAIL <br />MfV S53i9 crreohers(aassocfatedmechanlcaLcom <br />Dave Muellerleile <br />T1:STER CERTIFICATION # PHONE <br />754900 - 43711 952. 48-6100 <br />TEST EQUIPMENT MANUFACTURER TEST EQVIPMRNTMODEL # TEStEQUiPMENTSER1At # TE9r1NG EQUJPMSNi CAIIBRgTION DATE <br />Midwest' 845.. <br />r=— -- <br />— _ <br />843463 <br />_t _ Mn 12 Vs 1 O <br />rev. -... <br />nCNbd CC ,�, nemove _____ rte face and SN# of Re laced Device Rebu(Id <br />OVA <br />Type (check one): � Reduced Pressure Principal or Pressure Principal Fire Protection . vReduc�d Pressure Detector Fire Protection <br />.Double Chill Valve nay- y- rh....r, n...-- - ,-- <br />— - -- - •�,��•� ��1,CiDVl�vacuumrreaxer,,,�5pWResistant PresSUreVacuum Breaker <br />Nianufatturer: " K vA%.J %�7SX[ <br />Modef it se let# 3 5'ta`31/ -3/-, <br />System ServieedL X01 c E>Z ic.c �f She:, _ (Inches} <br />Loealil In bldg `�� N Floor q / Room N <br />:'r{{ 9tYinilrilciw <br />I, T <br />e Ia PrBssli Vii' <br />r Inc pa or educe' rasstireeti� „� a "titcilon <br />• � I � T6�T-R� UGiaF. • <br />Cheek Valva k2 Shutoff Valve N2 Check Valve #11 -FR <br />ressure Differential <br />Relief Valve <br />Initial C(osedT(ght „-_ es —No Closedylght �wNo Closed Tight _Yes No <br />Test Opened atpsid <br />Pressure Drop Across Check Valve R3 ` , Opsld <br />Final <br />ClosedTight ,..._Yes—No <br />Closed Tight _Yes _No <br />Closed 7TIght—Yes ,._.-NoTest <br />pressurss Che;Vatve #1 Opened at psid <br />._.._psid <br />DRpble Check Valve or Double Check Detector Vire Priafiectlati DC —YESr RESULTS <br />Check <br />Check Valve #ti Check Valve #Z Shutoff Valve 62 <br />_,Yes No psld C(osedT(ght _•, Yes No psid Closed T)ght _Yes No <br />PFInal <br />�No <br />,-, <br />CiosedTlght —Yes —No _Tpsid Closed Tight _ Yes std <br />P Closed Tight ,•._Yes No <br />Pressure Vacuum breaker PVB or Spill Resistant ltacuurrl Breaker (SRVBj —7>:ST RESULTS <br />Air (I Valve Check Valve shutoff #2 <br />Initial Test Failed to open _.,.Yes _ _No Closed Tight _Yes —No <br />0 erred at psid Pressure Drop Across Check Valve 41 psid Closed TI$ht „Yes _,••, No <br />Final Test Closed Tight _Yes No <br />Opened at . psid Check <br />Pressure prop Across Valve #1 sid Closed Tight _Yes, No <br />describe parts and repairs when needed: <br />Ct3RTIF1CA71ONt l hereby certify the foregoing Information provided by met torr of s twi thetas ed d sfunctloning in complio ce with <br />State of Minnesota Plum�ingCode, Chapter 473A. <br />• resrER'ssIGNATlIRIi- _ _ �,�/., �, <br />
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