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HomeMy WebLinkAbout09-10-2021 Regulated Backflow Assembly Test Report REGULATED BACKFLOW ASSEMBLY (RBA) FORM/TEST REPORT Service Site Address 800 NORTH OLD CRYSTAL BAY RD, LONG LAKE, MN, 55356 Service Site Name ORONO MIDDLE SCHOOL Work Order Number 272597 Contractor Name: Tester Name: Gilbert Mechancial 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:) Chi Reduce Pressure Principal or Pressure Principal Fire Protection Type of Work (Check One) Cir Test Manufacturer: System Serviced: Watts outside irrigation Model # Location in Bldg 009M2 boiler room near the loading dock Serial # Floor# 143088 1st Size (Inches) Room # 2" boiler/mechanical 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 Cl 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 6.8 4.0 5.0 Lbs. TEST RESULTS: 1 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: ;;a ij 11,6 iyti {{ \/ Date: 09/10/2021 t J e G REGULATED BACKFLOW ASSEMBLY (RBA) FORM/TEST REPORT Service Site Address 800 NORTH OLD CRYSTAL BAY RD, LONG LAKE, MN, 55356 Service Site Name ORONO MIDDLE SCHOOL Work Order Number 272597 Contractor Name: Tester Name: Gilbert Mechancial Contractors G 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:) U Reduce Pressure Principal or Pressure Principal Fire Protection Type of Work (Check One) L Test Manufacturer: System Serviced: Watts Boiler fill Model # Location in Bldg 909 Mechanical room near the loading dock Serial # Floor# 501319 1st Size (Inches) Room # 1" Boiler/mechanical 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 10 Yes I 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 8.8 3.2 6.0 Lbs. TEST RESULTS: E 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: i of fr , �. I , ' i • 1 � / I r/ Date: 09/10/2021