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HomeMy WebLinkAboutBackflow preventer tests RECEIVED SEP 3 0 2016 BACKFLOW PREVENTER TEST REPORT C�N OF ORONO - :�� G�� � � � I �- �� l 1 ,� .' C� , r71 <l � �l C/�� G� ��"��t l I , ( .I l:`l� � � / � L 1�1 10B ADDRESS(INCLUDE ADDRE55#,STREET NAME,&DIRECTIONAL),Apt/Unit# -' `_/. / ��_- � XJ�/ � / /�� yI , / / ��, -�cl j � � "y V V `/�U r[,�I��`C !�L "V G.;1 .:-1 L�1 /C�.-� � �� � V,� .. � . ( BACKFLOW ASSEMBLY INFORMATION (All Fields are Required) ,-, r _ �, �,, �__ System Served: �-����,� ;i�>c„"t' l:.�` � 9���'✓Manufacturer ofAssembly: �. -�.-< 1 �� ��' Model# ��� ��; � Size of Assembly: / ✓ Serial# �<T�� "� C� , � �� ��. Location of Assembly: Floor#1 L'��''l r�' Room# /1 �-� = �� Date test was performed:�_� � . � Reduced Pressure Principle Backflow Preventer(RP)—TEST RESULTS Check Valve#2 Shutoff Valve#2 Check Valve#1 Pressure Differential Relief Valve Closed Tight ❑Yesallo Closed Tight Q Yes IINo Closed Tight �Yes QVo Initial Test Pressure Drop Across Opened at psid Check Valve#1 psid Describe parts and repairs when needed Closed Tight �Yes_No Closed Tight ,�Yes_No Closed Tight �Yes_No l Final Test Pressure Drop Across Opened at � �' psid Check Valve#1 ���i� psid Double Check Backflow Prevention Assembly(DC)—TEST RESULTS Check Valve#1 Check Valve#2 Shutoff Valve#2 Closed Tight ales DIVo Closed Tight �Yes�Vo Closed Tight�Yes�No Initial Test psid psid Describe parts and repairs when needed Closed Tight _ es_ o Closed Tight _Yes_ o Closed Tight 0 Yes�No Pinal Test psid psid Pressure Vacuum Breaker Assembly(PVB)or Spiil Resistant Vacuum Breaker(SRVB)—TEST RESULTS Air Inlet Valve Check Valve Shutoff tf2 Failed to Ope _ e _No Ciosed Tight Yes�lo Closed Tight Ye No Initial Test Pressure Drop Across Opened at psid Check Valve#1 psid Describe parts and repairs when needed Closed Tight Yes_No Final Test Opened at psid Pressure Drop Across Closed Tight _Yes_No Check Valve#1 psid CERTIFICATION:I certify the foregoing information provided by me to be correct and that the tested device is functioning with the limits of the standards. ��,- j � , , _..._----��-'- �"�._ - �C�'n Name(Print):�`;,� � ��✓ Signature: /,-' �- Date:� a /� State of MN Certificate Number: G� ��7 �l C�"'�l..1 ��. ( RECEIVED SEP 3 0 2016 CITY OF ORONO BACKFLOW PREVENTER TEST REPORT C;,s�G,��, .� �,,, l 1 �, -,<<�_ 5�c`-. f-� ,=,' � `-� � ? S� G JOB ADDRE55(INCLUDE ADDRESS q,STREET NAME,&DIRECTIONAL),Apt/Unit# , ' � >h �SG� >GiU�� �,� > %!:: ���:�� �"'--� , t-� d��,iG!: � Sl 5`I BACKFLOW ASSEMBLY INFORMATION (All Fields are Required) , , , ,. ,;_. / System Served: �L��.S�� ����t��� � Manufacturer of Assembly:�:�.�� �L��� �� `� Model#�--f������/=i�/ �� � � � Size of Assembly: � � � Serial# C��7 / Location of Assembly: Floor# 1---� 1 ;'�� Room#/l � 1 ��� Date test was performed: l "//(�. Reduced Pressure Principle Backflow Preventer(RP)—TEST RESULTS Check Valve#2 Shutoff Valve#2 Check Valve#1 Pressure Differential Relief Valve Closed Tight ❑Yesallo Closed Tight Q Yes IINo Closed Tight �Yes QVo Initial Test Pressure Drop Across Opened at psid Check Valve#1 psid Describe parts and repairs when needed Closed Tight _Yes_No Closed Tight Yes No Closed Tight Yes No Final Test — — Pressure Drop Across Opened at_ psid Check Valve#1 psid Double Check Backflow Prevention Assembly(DC)—TEST RESULTS Check Valve#1 Check Valve#2 Shutoff Valve#2 Closed Tight aPes nNo Closed Tight 0 Yes�Vo Initial Test Closed Tight _Yes_No psid psid Describe parts and repairs when needed Closed Tight _ es_ o Closed Tight _Yes_ o Final Test Closed Tight 0 Yes�No psid psid Pressure Vacuum Breaker Assembly(PVB)or Spill Resistant Vacuum Breaker(SRVB)—TEST RESULTS Air Inlet Valve Check Valve Shutoff#2 Failed to Ope _ e _No Closed Tight Yes�lo Initial Test Pressure Drop Across Closed Tight Ye No Opened at psid Check Valve#1 psid Describe parts and repairs when needed ,� Closed Tight Yes_No � �� — Closed Tight �Yes No Final Test Opened at:�'�'y psid Pressure Drop Across — Check Valve#1 psid CERTIFICATION:I certify the foregoing infor,,m?ation provided by me to be correct and that the tested device is functioning with the limits of the standards. / /�� Name(Print): f�'l� � � ��� Signature: � C� L� Date:�� ' � ��� �5� � 7 ' State of MN Certificate Number: ��''�l �`'