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HomeMy WebLinkAbout09-10-2021 Regulated Backflow Assembly Test Report __ REGULATED BACKFLOW ASSEMBLY (RBA) FORM/TEST REPORT Service Site Address 795 NORTH OLD CRYSTAL BAY RD, LONG LAKE, MN, 55356 Service Site Name ORONO HIGH SCHOOL Work Order Number 272596 Contractor Name: Tester Name: Gilbert Mechanciai Contractors , Kenneth Thunder Contractor Address: Tester Certification #: 5251 W 74th Street, Edina, MN 55439 BF066234/ASSE 31412 Contractor License #: Test Equipment Manufacturer: 058808-PM WATTS Contractor Phone #: Test Equipment Model #: 952-835-3810 TK-9A Test Equipment Serial #: 853818 Testing Equipment Calibration Date: 05/10/2021 Backflow Assembly Detail Information (Check One:) Eli Reduce Pressure Principal or Pressure Principal Fire Protection Type of Work (Check One) E6 Test Manufacturer: System Serviced: Conbraco Boiler fill Model # Location in Bldg 4020402 Boiler room in the old ok kids building. Serial # Floor# K8383 1ST Size (Inches) Room # 3/4" Boiler room REGULATED BACKFLOW ASSEMBLY (RBA) FORM/TEST REPORT cont. Reduced Pressure Principal or Reduced Pressure Detector Fire Protection (RP)-TEST RESULTS Check Valve #2 (Closed Tight) Shutoff Valve #2 (Closed Tight) Check Valve #1 Initial Test Final Test ®Yes ®Yes 0 Yes (Closed Tight) Reduced Pressure Principal or Reduced Pressure Detector Fire Protection (RP)-TEST RESULTS Continued Check Valve Pressure Differential Relief Check Valve Static Line #1 Valve #2 Pressure Initial Test-Pressure Drop Across ps id Final Test-Pressure Drop Across psid Initial Test-Opened At psid Final Test-Opened At psid 7.4 2.6 5.8 Lbs. TEST RESULTS: CG PASS Double Check Valve or Double Check Detector Fire Protection Double Check Valve or Double Check Detector Fire Protection (DC)-TEST RESULTS (DC)-TEST RESULTS continued Check Check Shutoff Check Valve Check Valve Shutoff Valve Valve #1 Valve #2 Valve #2 #1 #2 #2 Initial Test-Closed Initial Test Tight psid Final Test Closed Final Test Tight psid Pressure Vacuum Breaker(PVB) or Spill Resistant Vacuum Pressure Vacuum Breaker(PVB) or Spill Resistant Vacuum Breaker(SRVB)-TEST RESULTS Breaker(SRVB)-TEST RESULTS continued Air Inlet Valve- Check Valve- Shutoff #2- Air Inlet Check Failed to Open Closed Tight Closed Tight Valve Valve Initial Initial Test-Opened at psid Test Final Test-Opened at psid Final Initial Test-Pressure Drop Across Test Check Valve#1 psid Final Test-Pressure Drop Across Check Valve#1 psid Describe parts and repairs when needed: Annual test only. Tester's Signature: 71 1 11 / }}t qi 1/ if °. ; j' i FI � ;i �1Jif / f l.%V' ,,�' i� Date: �1 09/10/2021 I ! GILBERT REGULATED BACKFLOW ASSEMBLY (RBA) FORM/TEST REPORT Service Site Address 795 NORTH OLD CRYSTAL BAY RD, LONG LAKE, MN, 55356 Service Site Name ORONO HIGH SCHOOL Work Order Number 272596 Contractor Name: Tester Name: Gilbert Mechancial Contractors L Kenneth Thunder Contractor Address: Tester Certification #: 5251 W 74th Street, Edina, MN 55439 BF066234/ASSE 31412 Contractor License #: Test Equipment Manufacturer: 058808-PM WATTS Contractor Phone #: Test Equipment Model #: 952-835-3810 TK-9A Test Equipment Serial #: 853818 Testing Equipment Calibration Date: 05/10/2021 Backflow Assembly Detail Information (Check One:) L Pressure Vacuum Breaker Type of Work (Check One) G Test Manufacturer: System Serviced: Febco outside irrigation Model # Location in Bldg 756-2 Outside near the old media center under a stainless steel Serial # shroud. 07061 Floor# o uts id e Size (Inches) 2" Room # outside REGULATED BACKFLOW ASSEMBLY (RBA) FORM/TEST REPORT cont. Reduced Pressure Principal or Reduced Pressure Detector Fire Protection (RP)-TEST RESULTS Check Valve #2 (Closed Tight) Shutoff Valve#2 (Closed Tight) Check Valve #1 Initial Test Final Test Reduced Pressure Principal or Reduced Pressure Detector Fire Protection (RP)-TEST RESULTS Continued Check Valve Pressure Differential Relief Check Valve Static Line #1 Valve #2 Pressure Initial Test-Pressure Drop Across psid Final Test-Pressure Drop Across psid Initial Test-Opened At psid Final Test-Opened At psid Lbs. TEST RESULTS: G PASS Double Check Valve or Double Check Detector Fire Protection Double Check Valve or Double Check Detector Fire Protection (DC)-TEST RESULTS (DC)-TEST RESULTS continued Check Check Shutoff Check Valve Check Valve Shutoff Valve Valve #1 Valve#2 Valve #2 #1 #2 #2 Initial Test-Closed Initial Test Tight psid Final Test Closed Final Test Tight psid Pressure Vacuum Breaker(PVB) or Spill Resistant Vacuum Pressure Vacuum Breaker(PVB) or Spill Resistant Vacuum Breaker(SRVB)-TEST RESULTS Breaker(SRVB)-TEST RESULTS continued Air Inlet Valve- Check Valve- Shutoff #2- Air Inlet Check Failed to Open Closed Tight Closed Tight Valve Valve Initial Initial Test-Opened at psid Test Final Test-Opened at psid 2.8 1.0 Final © No Q Yes ®Yes Initial Test-Pressure Drop Across Test Check Valve #1 psid Final Test-Pressure Drop Across Check Valve #1 psid Describe parts and repairs when needed: Annual test only. Tester's Signature: II �� l Psi t ; ii i . 1 i l�'�, j l,, i T, i I ^ tt N 7 i ' ;I I Date: 09/10/2021 ieGILBERT REGULATED BACKFLOW ASSEMBLY (RBA) FORM/TEST REPORT Service Site Address 795 NORTH OLD CRYSTAL BAY RD, LONG LAKE, MN, 55356 Service Site Name ORONO HIGH SCHOOL Work Order Number 272596 Contractor Name: Tester Name: Gilbert Mechancial Contractors C, Kenneth Thunder Contractor Address: Tester Certification #: 5251 W 74th Street, Edina, MN 55439 BF066234/ASSE 31412 Contractor License #: Test Equipment Manufacturer: 058808-PM WATTS Contractor Phone #: Test Equipment Model #: 952-835-3810 TK-9A Test Equipment Serial #: 853818 Testing Equipment Calibration Date: 05/10/2021 Backflow Assembly Detail Information (Check One:) E Pressure Vacuum Breaker Type of Work (Check One) EL Test Manufacturer: System Serviced: Febco outside irrigation Model# Location in Bldg 756-2 Outside by the old media center under a stainless steel Serial # shroud 07100 Floor# outside Size (Inches) 2" Room # outside REGULATED BACKFLOW ASSEMBLY (RBA) FORM/TEST REPORT cont. Reduced Pressure Principal or Reduced Pressure Detector Fire Protection (RP)-TEST RESULTS Check Valve#2 (Closed Tight) Shutoff Valve#2 (Closed Tight) Check Valve #1 Initial Test Final Test Reduced Pressure Principal or Reduced Pressure Detector Fire Protection (RP)-TEST RESULTS Continued Check Valve Pressure Differential Relief Check Valve Static Line #1 Valve #2 Pressure initial Test-Pressure Drop Across ps id Final Test-Pressure Drop Across ps id Initial Test-Opened At psid Final Test-Opened At psid Lbs. TEST RESULTS: G PASS Double Check Valve or Double Check Detector Fire Protection Double Check Valve or Double Check Detector Fire Protection (DC)-TEST RESULTS (DC)-TEST RESULTS continued Check Check Shutoff Check Valve Check Valve Shutoff Valve Valve #1 Valve#2 Valve#2 #1 #2 #2 Initial Test-Closed Initial Test Tight psid Final Test Closed Final Test Tight psid Pressure Vacuum Breaker(PVB) or Spill Resistant Vacuum Pressure Vacuum Breaker(PVB) or Spill Resistant Vacuum Breaker(SRVB)-TEST RESULTS Breaker(SRVB)-TEST RESULTS continued Air Inlet Valve- Check Valve- Shutoff #2- Air Inlet Check Failed to Open Closed Tight Closed Tight Valve Valve Initial Initial Test-Opened at psid Test Final Test-Opened at psid 3.2 1.0 Final ® No 0 Yes ®Yes Initial Test-Pressure Drop Across Test Check Valve #1 psid Final Test-Pressure Drop Across Check Valve #1 psid Describe parts and repairs when needed: Annual test only Tester's Signature: k, . t 110 i!I 'i l.✓ Date: 09/10/2021 ! ! cLBERT REGULATED BACKFLOW ASSEMBLY (RBA) FORM/TEST REPORT Service Site Address 795 NORTH OLD CRYSTAL BAY RD, LONG LAKE, MN, 55356 Service Site Name ORONO HIGH SCHOOL Work Order Number 272596 Contractor Name: Tester Name: Gilbert Mechan.cial Contractors C, Kenneth Thunder Contractor Address: Tester Certification #: 5251 W 74th Street, Edina, MN 55439 BF066234 Contractor License #: Test Equipment Manufacturer: 058808-PM WATTS Contractor Phone #: Test Equipment Model #: 952-835-3810 TK-9A Test Equipment Serial #: 853818 Testing Equipment Calibration Date: 05/10/2021 Backflow Assembly Detail Information (Check One:) Etii Pressure Vacuum Breaker Type of Work (Check One) C*6 Test Manufacturer: System Serviced: Wilkins Outside irrigation Model # Location in Bldg 720A Outside next to the Gas meter Serial # Floor# 350-08A outside Size (Inches) Room # 2" outside REGULATED BACKFLOW ASSEMBLY (RBA) FORM/TEST REPORT cont. Reduced Pressure Principal or Reduced Pressure Detector Fire Protection (RP)-TEST RESULTS Check Valve #2 (Closed Tight) Shutoff Valve#2 (Closed Tight) Check Valve #1 Initial Test Final Test Reduced Pressure Principal or Reduced Pressure Detector Fire Protection (RP)-TEST RESULTS Continued Check Valve Pressure Differential Relief Check Valve Static Line #1 Valve #2 Pressure Initial Test-Pressure Drop Across ps id Final Test-Pressure Drop Across psid Initial Test-Opened At psid Final Test-Opened At psid Lbs. TEST RESULTS: 66 PASS Double Check Valve or Double Check Detector Fire Protection Double Check Valve or Double Check Detector Fire Protection (DC)-TEST RESULTS (DC)-TEST RESULTS continued Check Check Shutoff Check Valve Check Valve Shutoff Valve Valve #1 Valve #2 Valve #2 #1 #2 #2 Initial Test-Closed Initial Test Tight psid Final Test Closed Final Test Tight psid Pressure Vacuum Breaker(PVB) or Spill Resistant Vacuum Pressure Vacuum Breaker(PVB) or Spill Resistant Vacuum Breaker(SRVB)-TEST RESULTS Breaker(SRVB)-TEST RESULTS continued Air Inlet Valve- Check Valve- Shutoff #2- Air Inlet Check Failed to Open Closed Tight Closed Tight Valve Valve Initial Initial Test-Opened at psid 3.2 2.8 Test Final Test-Opened at psid Final 0 No Q Yes d Yes Initial Test-Pressure Drop Across Test Check Valve #1 psid Final Test-Pressure Drop Across Check Valve #1 psid Describe parts and repairs when needed: Annual test only Tester's Signature: 1^i l #�.i If ,. f I / #�) +t � r u„,1/ r 1 / t Li i! / `•� Date: 09/10/2021 T REGULATED BACKFLOW ASSEMBLY (RBA) FORM/TEST REPORT Service Site Address 795 NORTH OLD CRYSTAL BAY RD, LONG LAKE, MN, 55356 Service Site Name ORONO HIGH SCHOOL Work Order Number 272596 Contractor Name: Tester Name: a e. Gilbert Mechancial Contractors G Kenneth Thunder Contractor Address: Tester Certification #: 5251 W 74th Street, Edina, MN 55439 BF066234/ASSE 31412 Contractor License#: Test Equipment Manufacturer: 058808-PM WATTS Contractor Phone #: Test Equipment Model #: 952-835-3810 TK-9A Test Equipment Serial #: 853818 Testing Equipment Calibration Date: 05/10/2021 Backflow Assembly Detail Information (Check One:) 66 Reduce Pressure Principal or Pressure Principal Fire Protection Type of Work (Check One) ( Test Manufacturer: System Serviced: Wilkins outside irrigation Model # Location in Bldg 375 Activity center mechanical room. Serial # Floor# 17850 L.L. Size (Inches) Room # 3" activity center mech room REGULATED BACKFLOW ASSEMBLY (RBA) FORM/TEST REPORT cont. Reduced Pressure Principal or Reduced Pressure Detector Fire Protection (RP)-TEST RESULTS Check Valve #2 (Closed Tight) Shutoff Valve #2 (Closed Tight) Check Valve #1 Initial Test Final Test d Yes ®Yes 0 Yes (Closed Tight) Reduced Pressure Principal or Reduced Pressure Detector Fire Protection (RP)-TEST RESULTS Continued Check Valve Pressure Differential Relief Check Valve Static Line #1 Valve #2 Pressure Initial Test-Pressure Drop Across ps id Final Test-Pressure Drop Across ps id Initial Test-Opened At psid Final Test-Opened At psid 9.2 2.8 8.2 Lbs. TEST RESULTS: G PASS Double Check Valve or Double Check Detector Fire Protection Double Check Valve or Double Check Detector Fire Protection (DC)-TEST RESULTS (DC)-TEST RESULTS continued Check Check Shutoff Check Valve Check Valve Shutoff Valve Valve#1 Valve #2 Valve #2 #1 #2 #2 Initial Test-Closed Initial Test Tight psid Final Test Closed Final Test Tight psid Pressure Vacuum Breaker(PVB) or Spill Resistant Vacuum Pressure Vacuum Breaker(PVB) or Spill Resistant Vacuum Breaker(SRVB)-TEST RESULTS Breaker(SRVB)-TEST RESULTS continued Air Inlet Valve- Check Valve- Shutoff #2- Air Inlet Check Failed to Open Closed Tight Closed Tight Valve Valve Initial Initial Test-Opened at psid Test Final Test-Opened at psid Final Initial Test-Pressure Drop Across Test Check Valve #1 psid Final Test-Pressure Drop Across Check Valve #1 psid Describe parts and repairs when needed: Annual test only Tester's Signature: '1 �'3 ii y ; , / is Ft1 t , tL1uJt;1 Date: 09/10/2021