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Old Crystal Bay Road South
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1000 Old Crystal Bay Road South- 09-117-23-11-0009
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Backflow preventer tests
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Last modified
8/22/2023 5:48:40 PM
Creation date
4/6/2018 11:20:59 AM
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x Address Old
House Number
1000
Street Name
Old Crystal Bay
Street Type
Road
Street Direction
South
Address
1000 Old Crystal Bay Rd S
Document Type
Misc
PIN
0911723110009
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MECHANICAL <br /> CONTRACTORS <br /> ST. PAUL, MN 122 S.Wabasha St.Suite 101, St.Paul,MN 55107 Office 651-777-0001 Fax 651-602-9296 <br /> REDUCED PRESSURE BACKFLOW PREVENTER TEST REPORT AND <br /> TESTABLE DOUBLE CHECKS <br /> Service Name: Met Council Contact Person/Tele: Chuck Lamere <br /> Address: 1000 Old Crystal Bay Rd. City: Orono State: MN Zip: <br /> Device Location:L59 (main room) Serve what system: Well <br /> Account Number: Serial Number: 1229419 <br /> Type: RP Make: Watts Model: 909 Size: 1 1/2" <br /> Install Date: Unknown Air Gap Installation Date: <br /> Rebuild Date: 6/21/2017 Test Date: 6/21/2012 rebuilt <br /> Annual Check Valve#1 Check Valve#2 Differential Pressure Relief Valve <br /> Report Pressure 7.6 Pressure 5.2 tight Opened at 3.6 psid reduced pressure. <br /> Did not open❑ <br /> ❑ Cleaned ❑ Cleaned ❑ Cleaned <br /> ❑ Replaced ❑ Replaced ❑ Replaced <br /> R ❑ Disc ❑ Disc ❑ Disc, Upper <br /> E ❑ Spring ❑ Spring ❑ Disc, Lower <br /> P ❑ Guide ❑ Guide ❑ Spring <br /> A ❑ Pin Retainer ❑ Pin Retainer ❑ Diaphragm, Large <br /> I ❑ Hinge Pin n Hinge Pin ❑ Lower <br /> R ❑ Seat ❑ Seat E Upper <br /> ❑ Diaphragm ❑ Diaphragm ❑ Diaphragm, Small <br /> S _ <br /> ® Other, describe ® Other, describe _ Lower <br /> 5-Year Rebuild Kit ❑ Upper <br /> ❑ Seat: <br /> ❑ Lower <br /> ❑ Upper <br /> ❑ Spacer, Lower <br /> ❑ Other, describe <br /> [ ] Sign and date Tag <br /> The above is certified correct. Signed <br /> DateTested 6/21/2012 <br /> Tested by (Print Name) SWwV Pei .rSOn' Certification Number 063817BF <br /> License Number 058169PM <br />
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