HomeMy WebLinkAbout06/07/2023 Backflow Test Report if CITY VIEW
Plumbing, Heating
JU 13 Zo23C r Conditioning loni
CITY OF OFZONC)
Job #133286825
Backflow Field Test Report Form
Property Information Rpz
Property Owner
Sandvold, Lynda
Property Owner Address
1140 Wyndmere Road, Wayzata, MN 55391 USA
Occupant of Property
Sandvold, Lynda
Occupant Address
1140 Wyndmere Road, Wayzata, MN 55391 USA
Test Equipment - Manufacturer: Wilkins Model#: TG-3 Serial #:
091010878 Calibration Date: 9/7/22
Device Information
Device Type
RPZ (ASSE1013)
Manufacturer Of Device
Zurn
Model #
975 xl
Size of Device
1 inch
Serial #
Aba6975
Location of Assembly
What is the Device Protecting?
Lawn rido rust system
Test Results Pass
Date of Test
2023-06-07
Time Test Was Performed
1030
Check Valve #2
Closed Tight
Shutoff Valve #2
Closed Tight
Check Valve #1
[;1 Closed Tight
Air Inlet Valve Opened At
PSID
8.1
Check Valve #1 psid
8.1
Pressure Differential Relief Valve
Opened at
2.1
Certified Tester Information
City View Plumbing and Heating 1880-B West Wayzata Blvd, Long Lake, MN 55356 952-473-
8793
Certified Tester Name
Dan Swanson
Certified Tester License Number
28072
Assembly Final Test Performance
PASS
Comments or Recommendations
Signature
Date
2023-06-07