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HomeMy WebLinkAbout09-10-2021 Regulated Backflow Assembly Test REGULATED BACKFLOW ASSEMBLY (RBA) FORM/TEST REPORT Service Site Address 685 NORTH OLD CRYSTAL BAY RD, LONG LAKE, MN, 55356 Service Site Name ORONO INTERMEDIATE SCHOOL Work Order Number 272595 Contractor Name: Tester Name: Gilbert Mechanciki Contractors u 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:) Edi Double Check Detector Fire Protection Type of Work (Check One) Eli Test Manufacturer: System Serviced: Ames Fire supression Model # Location in Bldg 2000 SS Maintenence shop in Mechanical room Serial # Floor# 78106 1st Size (Inches) Room # 4" mechanical 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 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: Eul 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 Ti ht Yes ID Yes Q Yes psid 2.6 5.4 9 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 (i I 3i ? r rr I F '1 l ' Al J: !1 Date: 09/13/2021 fe, GILBERT REGULATED BACKFLOW ASSEMBLY (RBA) FORM/TEST REPORT Service Site Address 685 NORTH OLD CRYSTAL BAY RD, LONG LAKE, MN, 55356 Service Site Name ORONO INTERMEDIATE SCHOOL Work Order Number 272595 Contractor Name: Tester Name: Gilbert Mechancial Contractors E6 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 Reduce Pressure Principal or Pressure Principal Fire Protection Type of Work (Check One) L Test Manufacturer: System Serviced: Apollo Pressure washer Model # Location in Bldg RPLF4A Maint bldg mechanical room Serial # Floor# 61082A 1st Size (Inches) Room # 1" mechanical 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 0 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 psid Final Test-Pressure Drop Across ps id Initial Test-Opened At psid Final Test-Opened At psid 7.4 3.2 5.8 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: A np III n ry ,r J; i •I• AI I ; . i!/ 1 / V' Date: 09/10/2021 ! GI1BERT REGULATED BACKFLOW ASSEMBLY (RBA) FORM/TEST REPORT Service Site Address 685 NORTH OLD CRYSTAL BAY RD, LONG LAKE, MN, 55356 Service Site Name ORONO INTERMEDIATE SCHOOL Work Order Number 272595 Contractor Name: Tester Name: Gilbert Mechancial Contractors t i Kenneth Thunder Contractor Address: Tester Certification #: 5251 W 74th Street, Edina, MN 55439 BF066234/ASSE31412 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: 05/17/2021 Backflow Assembly Detail Information (Check One:) G Reduce Pressure Principal or Pressure Principal Fire Protection Type of Work (Check One) Test Manufacturer: System Serviced: Watts outside irrigation Model # Location in Bldg 919 Maintence shop Mechanical room Serial # Floor# 32813 1st Size (Inches) Room # 2" mechanical 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 0 Yes 0 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 8.0 3.2 5.8 Lbs. TEST RESULTS: Et 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 11 11 i; n " 1 ! I i"`I� ` Date: 09/10/2021 GILBERT REGULATED BACKFLOW ASSEMBLY (RBA) FORM/TEST REPORT Service Site Address 685 NORTH OLD CRYSTAL BAY RD, LONG LAKE, MN, 55356 Service Site Name ORONO INTERMEDIATE SCHOOL Work Order Number 272595 Contractor Name: Tester Name: Gilbert Mechancial Contractors G Kenneth Thunder Contractor Address: Tester Certification #: 5251 W 74th Street, Edina, MN 55439 Bf066234/ASSE31412 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:) B Pressure Vacuum Breaker Type of Work (Check One) L Test Manufacturer: System Serviced: Febco outside irrigation Model # Location in Bldg 765 outside southside byncircular driveway Serial # Floor# 1234H 1st 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 psid Final Test-Pressure Drop Across ps id Initial Test-Opened At psid Final Test-Opened At psid Lbs. TEST RESULTS: Ef 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 Q No ©Yes ©Yes Initial Test-Pressure Drop Across Test Check Valve #1 psid Final Test-Pressure Drop Across Check Valve #1 psid 3.2 2.4 Describe parts and repairs when needed: Annual test only Tester's Signature: I IIs I ' r Y Date: 09/10/2021 .reGILBERT REGULATED BACKFLOW ASSEMBLY (RBA) FORM/TEST REPORT Service Site Address 685 NORTH OLD CRYSTAL BAY RD, LONG LAKE, MN, 55356 Service Site Name ORONO INTERMEDIATE SCHOOL Work Order Number 272595 Contractor Name: Tester Name: . Gilbert Mechancial Contractors CG Kenneth Thunder Contractor Address: Tester Certification #: 5251 W 74th Street, Edina, MN 55439 BF066234/ASSE31412 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:) E6 Pressure Vacuum Breaker Type of Work (Check One) E6 Test Manufacturer: System Servi:ed: Wilkins outside irrigation Model # Location in Bldg 720-A outside by Gas meters. Serial # Floor# na 1st 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 psid 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 Final No Yes d Yes Initial Test-Pressure Drop Across Test Check Valve#1 psid Final Test-Pressure Drop Across 2.8 2,0 Check Valve#1 psid Describe parts and repairs when needed: Annual test only Tester's Signature: n i !l' I , .^ (, i ; ; ' t ' li h\ '' I✓ Date: 09/10/2021