HomeMy WebLinkAboutBackflow Preventer Test 1-30-17 RECEIVEC
American Society of Sanitary Engineering o bZU,J
Reduced Pressure Principle Backflow Preventer (RP)
ASSE Standard #1013 Field Test Report CITY OF ORON
Owner of Property James&Vicki Splinter
Address 4005 North Shore Dr
City Orono State MN Zip Code 55364
Occupant of Property (if different from owner)
Occupant Address
City State Zip Code
Manufacturer of Device: Zurn Wilkins Model#: 375XLRP
Size of Device: 1" Serial#: B166914
Location of Assembly and Equipment or System Application: Pool Feed
Test Equipment:
Manufacturer: Wilkins Model#: TG-3 Serial#: 091010878
Calibration Date:02/18/2015
Date test was performed: 1/30/2018 Time test was performed: 3:00 PM Static Line Pressure:
Check Valve#2 Shutoff valve#2 Check Valve#1 Pressure Differential
Relief Valve
Leaking (0)
Initial Test Leaking CI) Leaking CI) Closed Tight (0)
Closed Tight (0) Closed Tight (0) Pressure Drop Across Opened at psid
Check Valve#1 _psid
Describe parts
and repairs
when needed
Leaking ([D
Leaking CI) Leaking l) Closed Tight (0)Final Test Closed Tight (0) Closed Tight (13Pressure Drop Across Opened at 44psid
Check Valve#1 52 psid
Certified Tester (print)Dan Swanson Assembly Final Test
Address 1880-B West Wayzata Blvd Performance
City Long lake State MN Zip 55356
Phone#: 95 3-8793 Pass II
License#: P 0613r Certi -tion # 28072 Fail
Signature Date: 1/30/2018
Comments or Recommendations (continue to other side,if needed):