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HomeMy WebLinkAboutsprinkler system info/inspections 1301 L'Orient Street St.Paul,Minnesota 55117 (651)558-3300 • (800)229-6263 AUTOMATIC SPRINKLER CO. Fax: (651)558-3310 Setting Ti;tee Standard,.. AGREEMENT AND REPORT OF INSPECTION SHEET 1 of 2-Use separate sheet for each building inspected #INSPECTION MINNESOTA LICENSE NO.CW5 REPORT TO 3,j q Q k :W, J u � �( BUIL�}DING OR LOCATION -5,04 t"-P STREET (_4:5 a l J C x-!y4 /,ti A4 u no-d/ INSPEC'T'OR /A 7- 640 CITY&STATE ©X a-10 � f1/1,J. DATE /y-s6,_d Owner hires Viking Automatic Sprinkler Company to conduct an inspection of the fire suppression system at the above location or building,and prepare a written report of that inspection for an agreed upon fee. As part of this agreement,owner agrees to terms and conditions on rear of form and will complete the Owner's Section of this document. Owner's Section(To be answered by Owner or Occupant) A. Explain any occupancy hazard changes since the previous inspection: i(J o/.1 CZ B. Describe fire protection modifications made since last inspection: �A 1 4) C. Describe any fires since last inspection: 4)t-;;,k) d D. When was the system piping last checked for stoppage,corrosion or foreign material? T) E. When was the dry-piping system last checked for proper pitch? wig F. Are dry valves adequately protected fr=_�Xl ? Ad Signature _4 — Date Inspector's Section(All responses reference current inspection) N/A=NOT APPLICABLE 1 General a. Is the building occupied?)Yes ❑No b. Are all systems in service?plyes ❑No c. Does there appear to be a minimum of 18 in.(457 mm)clearance between the top of thest rage and the sprinkler deflectors?>Yes ❑No d. Does the valve hose on the sprinkler system(s)appear to be satisfactory? ❑Yes ❑No i N/A 2 Control Valves(See Item 15) a. Do sprinkler system control valves appear to be in the appropriate open or closed position? A Yes ❑No b. Are control valves in the open position locked,sealed or equipped with a tamper switch?,)gYes ❑No 3 Water Supplies(See Item 16) �- a. Was a water flow test of main drain made at the sprinkler riser(s)? AC es ❑No 4 Tanks,Pumps,Fire Department Connections a. Are fire pumps,gravity tanks,reservoirs and pressure tanks in good condition and properly maintained? ❑Yes u No AQV/A b. Are fire department connections in satisfactory condition,couplings free,caps in place,and check valves tight? 91Yes ❑No ❑N/A Are they accessible and visible?*Yes n No ❑N/A 5 Wet Systems a. Are cold weather valves(O.S.&Y.)in the appropriate open or closed position?A.Yes ❑No n N/A b. Have antifreeze system solutions been tested? ❑Yes ❑No PN N/A c. Were the antifreeze test results satisfactory? ❑Yes ❑No &tN/A d. In areas protected by wet system(s),does the building appear to be properly heated in all areas,including blind attics and perimeter areas where accessible?p4Yes n No ❑N/A Do all exterior openings appear to be protected against freezing?rXYes ❑No n N/A 6 Dry System(See Items 11 to 13) a. Are dry valves(s)in service? ❑Yes ❑No (,4 N/A b. Are the air pressures and priming water levels in accordance with the manufacture's instructions? ❑Yes ❑No A4 N/A c. Has the operation of the air or nitrogen supplies been tested? ❑Yes ❑No p(N/A Are they in service? ❑Yes ❑No ,h�/A d. Were all know low points drained during this inspection? ❑Yes ❑No /FN/A e. Did quick-opening devices operate satisfactorily? ❑Yes ❑No vtQN/A f. Did the dry valve(s)trip properly during the trip pressure test? ❑Yes ❑No �N/A g. Did the heating equipment in the dry-pipe valve room(s)operate at time of inspection? ❑Yes ❑No CWN/A 7 Special Systems(See Item 14) a. Did the deluge or pre-action valves operate properly during testing? ❑Yes ❑No p4q/A b. Did the heat-responsive devices operate properly during testing? ❑Yes ❑No XN/A c. Did supervisory devices operate during testing? ❑Yes n No /dN/A 8 Alarms a. Did water motor(s)and gong(s)test satisfactorily? ❑Yes ❑No ,*N/A b. Did electric alarm(s)test satisfactory?X Yes ❑No ❑N/A c. Did supervisory alarm service test satisfactory?XYes ❑No ❑N/A 9 Sprinklers a. Do visible sprinklers appear to be free from corrosion,loading or obstruction to spray discharge?AYes ❑No b. Are sprinklers less than 50 years old? (Older sprinklers require sample testing)�Yes ❑No c. Are quick response and residential sprinklers less than 20 years old? (Older sprinklers require sample testing)Yes ❑No ❑N/A d. Is stock of spare sprinklers available? Yes ❑No e. Does the exterior condition of sprinkll system appear to be satisfactory?91-Yes ❑No f. Do visible sprinklers appear to be of proper temperature rating for their locations?�P Yes ❑No 10 Explain any"No"answers and comments: Signature: �2 _ _ Date: Terms and Limitations 1 This Agreement is for inspection services only. If Subscriber wants the Company to make any repairs, alterations or replacements as a result of this inspection, the Company will do so for additional compensation to ' be agreed upon in writing by the parties. 2 The Company does not know and does not represent whether the current fire protection system on the Property was originally designed and installed in such a way that the system will perform as originally intended or is suitable and sufficient for its intended purpose given the way in which the Property has been or will be used. In other words, the Property has been or may be used in ways such that the configuration of partition walls, the location of and type of materials (including the presence of hazardous materials) and other conditions of the Property's use are such that the fire protection system is inadequate, insufficient or unsuitable for the Property. THIS REPORT IS NOT A GUARANTEE OR WARRANTY THAT THE SYSTEM WILL IN ALL CASES (A) PROVIDE THE LEVEL OF PROTECTION FOR WHICH IT WAS ORIGINALLY INTENDED(B) IS FREE OF ALL DEFECTS AND DEFICIENCIES(C)AND IS IN COMPLIANCE WITH ALL APPICABLE CODES. 3 The Company's inspection will not include every sprinkler head, pipe or other parts of the fire protection sprinkler system that currently exist and is limited to a visual inspection of external readily accessible parts of the system. The Company shall only be obligated to inspect a representative number or sample of the sprinkler heads, pipes, hangers,valves or other devices and equipment in their current position. 4 The Company will be permitted, at all reasonable times, to enter the Property indicated above to conduct the inspection as outlined in this Agreement. 5 The Company's potential liability arising out of its inspection services must be limited. THEREFORE, THE LIABILITY, IF ANY, OF THE COMPANY TO THE SUBSCRIBER AND/OR OTHER OCCUPANTS OR VISITORS OF THE PROPERTY ARISING OUT OF THE COMPANY'S INSPECTION. REPORT, ACT OR OMISSION OR FAILURE TO ACT, OR ANY CLAIMED BREACH OF THIS AGREEMENT BY THE COMPANY, SHALL IN NO EVENT EXCEED THE TOTAL FEE PAID BY THE SUBSCRIBER FOR THE INSPECTION SERVICES THAT GIVE RISE TO ANY SUCH LIABILITY. 6 The Company, following each inspection, will provide to the Subscriber a written "Report of Inspection" ("Report"). If required by state or local codes, the Company will provide a copy of the Report to fire and/or building officials. If desired, a copy of the Report will also be forwarded to the Subscriber's insurance company. The Report and recommendations by the Company are only advisory in nature and are intended to assist the Subscriber in reducing the possibility of loss to the Property by indicating obvious defects or impairments to the fire protection system(s) which were discovered by the Company's inspection and which should receive prompt attention. 7 Subscriber agrees to obtain and shall be soley responsible to maintain insurance for the Property, all contents therein, and/or operations performed within or around the Property to be inspected. 8 The Subscriber agrees to assume the entire responsibility and liability, to the fullest extent permitted by law, for all damages or injury to all persons, whether employees or otherwise, and to all property, arising out of it, resulting from or in any manner connected with, the execution of the work provided for in this Inspection Agreement or occurring or resulting from the use by the Company or its agents or employees of materials, equipment, instrumentalities or other property, whether the same be owned by the Subscriber, the Company or third parties, and the Subscriber, to the fullest extent permitted by law, agrees to indemnify and save harmless the Company, its agents and employees from all such claims including, without limiting the generality of the foregoing, claims for which the Company may be or may be claimed to be, liable and legal fees and disbursement paid or incurred to enforce the provisions of this paragraph and the Subscriber further agrees to obtain, maintain and pay for such general liability insurance coverage and endorsements as will insure the provisions of this paragraph. 9 While the Company will make every reasonable effort to prevent the discharge of water into or onto areas of landscaping, decorative pavement, etc., it is the Subscriber's responsibility to provide sufficient and readily accessible means to accept the full flow of water that may be required by tests as determined by the type of inspection. 10 This Agreement may not be assigned by Subscriber without the written consent of the Company. 11 This Agreement may be signed in counterparts; a signed facsimile, photocopy, and/or electronic mail of this Agreement shall be as binding on both parties just as though this Agreement were executed in its original, pre- printed form. 12 If payment for work provided in this Agreement is not paid when due, Subscriber agrees to pay all costs of collection including attorney's fees. (Rev.2/8/06) 1301 L'Orient Street . . St.Paul,Minnesota 55117 AUTONATIC SPRINKLER CO. (651)558-3300 • (800)229-6263 Setting.The Standard... Fax: (651)558-3310 SHEET 2 of 2-Use separate sheet for each system inspected System No.or Description if multiple systems - 4J* Inspection Report No. �j $ 11 Date dry-pipe valve trip tested(control valve partially open) i,1 (See Trip Test Table which follows) 12 Date dry-pipe valve trip tested(control valve fully open) Al/'°- (See Trip Test Table which follows) 13 Date quick-opening device tested Al 1:2 See Trip Test Table which follows) DRY VALVE TRIP TEST TABLEQ.O.D. MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. DRY PIPE Time to Trip Water Air Trip Point Time Water Reached Alarm Operated OPERATING Thru Test Pipe Pressure Pressure Air Pressure Test Outlet Properly TEST MIN. SEC. PSI PSI PSI MIN. SEC. YES NO Without Q.O.D With Q.O.D 14 Date deluge or preaction valve tested Al (See Trip Test Table which follows) TRIP TEST TABLE Operation ❑PNEUMATIC ❑ELECTRIC ❑HYDRAULIC Piping Supervised ❑ YES ❑ NO IDetecting Media Supervised ❑ YES ❑ NO DELUGE& Does valve operate from the manual trip and/or remote control stations ❑ YFI, ❑ NO PREACTION Is there an accessible facility in each circuit for testing ❑ YES ❑ NO IMethod of Testing Circuits VALVES Does each circuit operate Does each circuit Maximum time to MAKE MODEL supervision loss alarm operate valve release operate release YES NO YES I NO YES NO 15 See Control Valve Maintenance Table CONTROL VALVE MAINTENANCE TABLE Explain Abnormal Control Valves Number Type Open Secured Closed Signs Condition City Control Valves r < Bypess Valves Tank Control Valves Pump Control Valves Sectional Control Valves System Control Valves .5 5 yj Other Control Valves Kitchen Control Valves P < p p S 16 Water Flow Test at Sprinkler Riser Water Supply Source: Ci ' Tank Pum Residual Test Pipe Size of Static (Flow) Date Location Test Pie Pressure Pressure Last Water Flow Test 2. i S 0,0?-,; This Water Flow Test 4 -_02 6 , 5 Q ee 5 Z ` 17 Explain any"No"answers and comments: 18 Adjustments or c rrections made durin tis inspection: p Qn J�4 0< C PC* e .soft cS 5t G,s.lfl�1 S 19 Although these comments are t the result of an engineering review,the fol wing desirable improvements are reco�l/Amended: J. !•)Ye,C)AAXQ A ac< <f Ge k.t� !.fie Cf n.,e�rJ�CrV Signature: T' _ Date: /Q -16, U (Rev.2/8/06) Terms and Limitations Aw 1 This Agreement is for inspection services only. If Subscriber wants the Company to make any repairs, alterations or replacements as a result of this inspection, the Company will do so for additional compensation to be agreed upon in writing by the parties. 2 The Company does not know and does not represent whether the current fire protection system on the Property was originally designed and installed in such a way that the system will perform as originally intended or is suitable and sufficient for its intended purpose given the way in which the Property has been or will be used. In other words, the Property has been or may be used in ways such that the configuration of partition walls, the location of and type of materials (including the presence of hazardous materials) and other conditions of the Property's use are such that the fire protection system is inadequate, insufficient or unsuitable for the Property. THIS REPORT IS NOT A GUARANTEE OR WARRANTY THAT THE SYSTEM WILL IN ALL CASES (A) PROVIDE THE LEVEL OF PROTECTION FOR WHICH IT WAS ORIGINALLY INTENDED(B) IS FREE OF ALL DEFECTS AND DEFICIENCIES(C)AND IS IN COMPLIANCE WITH ALL APPICABLE CODES. 3 The Company's inspection will not include every sprinkler head, pipe or other parts of the fire protection sprinkler system that currently exist and is limited to a visual inspection of external readily accessible parts of the system. The Company shall only be obligated to inspect a representative number or sample of the sprinkler heads, pipes, hangers,valves or other devices and equipment in their current position. 4 The Company will be permitted, at all reasonable times, to enter the Property indicated above to conduct the inspection as outlined in this Agreement. 5 The Company's potential liability arising out of its inspection services must be limited. THEREFORE, THE LIABILITY, IF ANY, OF THE COMPANY TO THE SUBSCRIBER AND/OR OTHER OCCUPANTS OR VISITORS OF THE PROPERTY ARISING OUT OF THE COMPANY'S INSPECTION, REPORT, ACT OR OMISSION OR FAILURE TO ACT, OR ANY CLAIMED BREACH OF THIS AGREEMENT BY THE COMPANY, SHALL IN NO EVENT EXCEED THE TOTAL FEE PAID BY THE SUBSCRIBER FOR THE INSPECTION SERVICES THAT GIVE RISE TO ANY SUCH LIABILITY. 6 The Company, following each inspection, will provide to the Subscriber a written "Report of Inspection" ("Report"). If required by state or local codes, the Company will provide a copy of the Report to fire and/or building officials. If desired, a copy of the Report will also be forwarded to the Subscriber's insurance company. The Report and recommendations by the Company are only advisory in nature and are intended to assist the Subscriber in reducing the possibility of loss to the Property by indicating obvious defects or impairments to the fire protection system(s) which were discovered by the Company's inspection and which should receive prompt attention. 7 Subscriber agrees to obtain and shall be soley responsible to maintain insurance for the Property, all contents therein, and/or operations performed within or around the Property to be inspected. 8 The Subscriber agrees to assume the entire responsibility and liability, to the fullest extent permitted by law, for all damages or injury to all persons, whether employees or otherwise, and to all property, arising out of it, resulting from or in any manner connected with, the execution of the work provided for in this Inspection Agreement or occurring or resulting from the use by the Company or its agents or employees of materials, equipment, instrumentalities or other property, whether the same be owned by the Subscriber, the Company or third parties, and the Subscriber, to the fullest extent permitted by law, agrees to indemnify and save harmless the Company, its agents and employees from all such claims including, without limiting the generality of the foregoing, claims for which the Company may be or may be claimed to be, liable and legal fees and disbursement paid or incurred to enforce the provisions of this paragraph and the Subscriber further agrees to obtain, maintain and pay for such general liability insurance coverage and endorsements as will insure the provisions of this paragraph. 9 While the Company will make every reasonable effort to prevent the discharge of water into or onto areas of landscaping, decorative pavement, etc., it is the Subscriber's responsibility to provide sufficient and readily accessible means to accept the full flow of water that may be required by tests as determined by the type of inspection. 10 This Agreement may not be assigned by Subscriber without the written consent of the Company. 11 This Agreement may be signed in counterparts; a signed facsimile, photocopy, and/or electronic mail of this Agreement shall be as binding on both parties just as though this Agreement were executed in its original, pre- printed form. 12 If payment for work provided in this Agreement is not paid when due, Subscriber agrees to pay all costs of collection including attorney's fees. (Rev.2/8/06) e CORVAL GROUP .♦ 1633 Eustis Street, St Paul, Minnesota 55108-1219 (651)645-0451 Fax: (651)642-5591 An Affirmative Action, Equal Opportunity Employer TO: Justin McCoy DATE: July 6, 2011 ISD 278 Orono Schools PROJECT: RPZ Testing 685 Old Crystal Bay Road LOCATION: Orono H.S. & Orono M.S. Orono, MN 55356 OUR PROJECT NO.: 154235 WE ARE SENDING YOU: ®Attached ❑Change Order ❑Specifications ❑Shop Drawings ❑Under Separate Cover ❑Copy of Letter ❑Prints ❑Request for Change ❑Thru Messenger ❑Plans ❑Samples ❑Purchase Order No. ITEM REFERENCE NO.OF TRANSMITTED NO. SECTION NO. COPIES DESCRIPTION AND REFERENCE DATA PER CODE BELOW 1 1 Backflow Preventer Test Report for Serial # 501319 3 2 1 Backflow Preventer Test Report for Serial # 143091 3 3 1 Backflow Preventer Test Report for Serial # 143088 3 TRANSMITTAL CODES: 1. For Acknowledgment 6. Approved as Submitted 2. For Approval 7. Approved as Noted 3. For Your Use 8. Resubmii Copies for Approval 4. As Requested 9. Release for production as per delivery date indicated on our Purchase Order 5. For Review and Comment 10.Furnish changes in contract price,if affected,by 11. Other: REMARKS: Copy To: 1. Project Manager File 2. Follow-up File City of Orono CorVal Constructors, Inc. Doug 7kachuck/Service.41anager RECEIVED JUL -7 2011 CITY OF ORONO : + CORVAL BACKFLOW PREVENTER TEST REPORT DATE: / Site Name: Orono Middle School Job# Site Address: 800 Old Crystal Bay Rd City: Orono Zip Code: 55356 Contact: John Ostlyng Phone#:612.919.1769 Owner: ISD 278 Orono Schools Phone#: 952.449.8345 Owner Address:685 Old Crystal Bay Road City: Orono Zip Code: 55356 Make/Model of Device: Watts 909 QT Size: 1" Serial#: 501319 Serves What System: Boiler Make-up Water Location: Boiler Room Ck Valve Pres. Dif.Across Pres. Dif.when Ck Valve#1 #2 #1 Ck relief opens Strainer Leaked( ) Leaked ( None( ) Test before Repair Close Close PSI PSI Clnd Describe Repair Final Test Materials Leaked( Leaked ( one Used Close Close PSI ` PSI Clnd (� CERTIFICATION: I hereby certify the foregoing data to be correct and that the tested device is functioning within the limits of the `standards. :t< NAME: Corval Constructors, Inc. ADDRESS: 1633 Eustis Street St. Paul NIN 55108 BY: 7� CERTIFICATION#: PHONE: 651-645-0451 '3 DATE: REMARKS: O INSTALL ATEST O REBUILD ORIGINAL INSTALLATION DATE: 2000 DATE OF LAST REBUILD: 2005 CORVAL BACKFLOW PREVENTER TEST REPORT DATE: /r Site Name: Orono Middle School Job# Site Address:800 Old Crystal Bay Rd City: Orono Zip Code: 55356 Contact:John Ostlung Phone#:612.919.1769 Owner: ISD 278 Orono Schools Phone#:952.449.8345 Owner Address: 685 Old Crystal Bay Road City:Orono Zip Code: 55356 Make/Model of Device: Watts 009 M2QT Size: 2" Serial#: 143091 Serves What System: Lawn Irrigation Location: Boiler Room Ck Valve Pres. Dif.Across Pres. Dif,when Ck Valve#1 #2 #1 Ck relief opens Strainer Leaked( ) Leaked( ) None( ) Test before Repair Close Close PSI PSL Clnd Describe Repair Final Test Materials Leaked( —Leaked( ) None„-" Used Close Close PSI i PSI,5,,e Clnd CERTIFICATION: K I hereby certify the foregoing data to be correct and that the tested device is functioning within the limits of the standards. FIRM NAME: Corval Constructors, Inc. ADDRESS: 1633 Eustis Street St. Paul MN 55108 BY: i1 CERTIFICATION#: C�217 - PRONE: 651-645-0451 DATE: REMARKS: ( ) INSTALL A, TEST ( ) REBUILD ORIGINAL INSTALLATION DATE: 2000 DATE OF LAST REBUILD: 2006 CORVAL BACKFLOW PREVENTER TEST REPORT DATE: - Site Name: Orono Middle School Job# Cj� 3S Site Address: 800 Old Crystal Bay Rd City: Orono Zip Code: 55356 Contact: John Ostlyng Phone#:612.919.1769 Owner: ISD 278 Orono Schools Phone#:952.449.8345 Owner Address: 685 Old Crystal Bay Road City: Orono Zip Code: 55356 Make/Model of Device: Watts 909 QT Size: 2° Serial#: 143088 Serves What System: Irrigation Location: Boiler Room Ck Valve Pres. Dif.Across Pres. Dif.when Ck Valve#1 #2 #1 Ck relief opens Strainer Leaked( ) Leaked( None( ) Test before Repair Close Close PSI PSI Clnd Describe Repair Final Test Materials Leaked ( Leaked( ) None Used Close Close PSI �' PSI . Z Clnd CERTIFICATION: I hereby certify the foregoing data to be correct and that the tested device is functioning within the limits of the standards. FIRM NAME: Corval Constructors, Inc. ADDRESS: 1633 Eustis Street St. Paul NIN 55108 BY: `.!�G ej-C47i CERTIFICATION#: Ja 1 PHONE: 651-645-0451 DATE: :�!— ,-- / I REMARKS: ( ) INSTALL ( j TEST ( ) REBUILD ORIGINAL INSTALLATION DATE: 2000 DATE OF LAST REBUILD: 2005 i / o CORVAL GROUP i 1633 Eustis Street, St Paul, Minnesota 55108-1219 (651)645-0451 Fax: (651)642-5591 An Affirmative Action, Equal Opportunity Employer TO: Justin McC DATE: July 17, 2012 ISD 278 Orono Scho PROJECT: RPZ Testing LOCATION: Orono H.S. & Orono M.S. Orono, MN 55356 OUR PROJECT NO.: 156525 WE ARE SENDING YOU: ®Attached ❑Change Order ❑Specifications ❑Shop Drawings ❑Under Separate Cover ❑Copy of Letter ❑Prints ❑Request for Change ❑Thru Messenger ❑Plans []Samples ❑Purchase Order No. ITEM REFERENCE NO.OF TRANSMITTED NO. SECTION NO. COPIES DESCRIPTION AND REFERENCE DATA PER CODE BELOW 1 1 Backflow Preventer Test Report for Serial # 501319 3 2 1 Backflow Preventer Test Report for Serial # 143091 3 3 1 Backflow Preventer Test Report for Serial # 143088 3 TRANSMITTAL CODES: 1. For Acknowledgment 6. Approved as Submitted 2. For Approval 7. Approved as Noted 3. For Your Use 8. Resubmit Copies for Approval 4. As Requested 9. Release for production as per delivery date indicated on our Purchase Order 5. For Review and Comment 10. Furnish changes in contract price,if affected, by 11. Other: REMARKS: Copy To: 1. Project Manager File 2. Follow-up File City of Orono CorVal Constructors, Inc. Doug 7kachucklService Tanager s -® BACKFLOW PREVENTER TEST REPORT DATE:_ Site Name: Orono Middle School Job# Site Address:800 Old Crystal Bay Rd City: Orono Zip Code: 55356 Contact:John Ostlung Phone#:612.919.1769 Owner: ISD 278 Orono Schools Phone#: 952.449.8345 Owner Address: 685 Old Crystal Bay Road City: Orono Zip Code: 55356 Make/Model of Device: Watts 009 M2QT Size: 2" Serial#: 143091 Serves What System: Lawn Irrigation Location: Boiler Room Ck Valve Pres. Dif.Across Pres. Dif.when Ck Valve#1 #2 #1 Ck relief opens Strainer Leaked( ) Leaked( None( ) Test before Repair Close Close PSI PSI Clnd Describe Repair Final Test Materials Leaked( Leaked ( Noner(4 Used Close Close PSIPSI Clnd CERTIFICATION: I hereby certify the foregoing data to be correct and that the tested device is functioning within the limits of the standards. FIRM NAME: Corval Constructors, Inc. ADDRESS: 1633 Eustis Street St. Paul MN 55108 BY: ll-/e&., ,c 7�;Jd CERTIFICATION#: U,6 6r�3;'S- PHONE: 651-645-0451 DATE: 7- Z,2 - ,26,6®2 REMARKS: ( ) INSTALL (TEST ( )REBUILD ORIGINAL INSTALLATION DATE: 2000 DATE OF LAST REBUILD: -2996- 76ld CORVA BACKFLOW PREVENTER TEST REPORT DATE: Site Name: Orono Middle School Job# Site Address:800 Old Crystal Bay Rd City: Orono Zip Code: 55356 Contact: John Ostlung Phone#:612.919.1769 Owner: ISD 278 Orono Schools Phone#: 952.449.8345 Owner Address:685 Old Crystal Bay Road City: Orono Zip Code: 55356 Make/Model of Device: Watts 909 QT Size: 1" Serial#: 501319 Serves What System: Boiler Make-up Water Location: Boiler Room Ck Valve Pres. Dif.Across Pres. Dif.when Ck Valve#1 #2 #1 Ck relief opens Strainer Leaked ( ) Leaked ( ) None Test before Repair Close Close ? PSI PSI Clnd Describe Repair Final Test Materials Leaked( ) Leaked( None( ) Used Close Close PSI PSI Cind CERTIFICATION: I hereby certify the foregoing data to be correct and that the tested device is functioning within the limits of the standards. FIRM NAME: Corval Constructors, Inc. ADDRESS: 1633 Eustis Street St. Paul MN 55108 CERTIFICATION#: PHONE: 651-645-0451 DATE: Z-/2-626 i.Z REMARKS: ( ) INSTALL / TEST ( ) REBUILD ORIGINAL INSTALLATION DATE: 2000 DATE OF LAST REBUILD: --20G� 10 (Clu BACKFLOW PREVENTER TEST REPORT DATE:_- Site Name: Orono Middle School Job# Site Address:800 Old Crystal Bay Rd City: Orono Zip Code: 55356 Contact:John Ostlung Phone#:612.919.1769 Owner: ISD 278 Orono Schools Phone#:952.449.8345 Owner Address:685 Old Crystal Bay Road City: Orono Zip Code: 55356 Make/Model of Device: Watts 909 QT Size: 2° Serial#: 143088 Serves What System: Irrigation Location: Boiler Room Ck Valve Pres. Dif.Across Pres. Dif, when Ck Valve#1 #2 #1 Ck relief opens Strainer Leaked( ) Leaked( None( ) Test before Repair Close Close PSI PSI Clnd Describe Repair Final Test Materials Leaked O Leaked( None Used Close Close PSI PSI Cln CERTIFICATION: I hereby certify the foregoing data to be correct and that the tested device is functioning within the limits of the standards. FIRM NAME: Corval Constructors, Inc. ADDRESS: 1633 Eustis Street St. Paul MN 55108 BY: l CERTIFICATION#: (,2 ? PHONE: 651-645-0451 DATE: f?� tj / REMARKS: ( ) INSTALL (NEST ( ) REBUILD ORIGINAL INSTALLATION DATE: 2000 ,V DATE OF LAST REBUILD: 2985- 1-26/10 CORVAL GROUP- •� r 1633 Eustis Street, St Paul, Minnesota 55108-1219 (651)645-0451 Fax: (651)642-5591 An Affirmative Action, Equal Opportunity Employer TO: Mike Daniels DATE: 8/8/14 ISD 278 Orono Schools PROJECT: RPZ Testing 685 Old C stry al Bay Road LOCATION: Discovery Center Orono, MN 55356 OUR PROJECT NO.: 1541 WE ARE SENDING YOU: ®Attached ❑Change Order ❑Specifications ❑Shop Drawings ❑Under Separate Cover ❑Copy of Letter ❑Prints [--]Request for Change ❑Thru Messenger ❑Plans []Samples ❑Purchase Order No. ITEM REFERENCE NO.OF TRANSMITTED NO. SECTION NO. COPIES DESCRIPTION AND REFERENCE DATA PER CODE BELOW 1 1 Backflow Preventer Test Report for Serial#280429 3 TRANSMITTAL CODES: 1. For Acknowledgment 6. Approved as Submitted 2. For Approval 7. Approved as Noted 3. For Your Use 8. Resubmit Copies for Approval 4. As Requested 9. Release for production as per delivery date indicated on our Purchase Order 5. For Review and Comment 10.Furnish changes in contract price,if affected,by 11. Other: REMARKS: Copy To: 1. Project Manager File 2. Follow-up File Corval Constructors, Inc. City of Orono Doug 7kackuck/Service Manager 0 Y C L 1633 Eustis Street, St Paul, Minnesota 55108-1219 (651)645-0451 Fax: (651)642-5591 An Affirmative Action, Equal Opportunity Employer TO: Mike Daniels DATE: 8/8/14 ISD 278 Orono Schools PROJECT: RPZ Testing 685 Old Crystal Bay Road LOCATION: OK Kids Orono, MN 55356 OUR PROJECT NO.: 1541 WE ARE SENDING YOU: ®Attached ❑Change Order ❑Specifications ❑Shop Drawings ❑Under Separate Cover ❑Copy of Letter ❑Prints ❑Request for Change ❑Thru Messenger ❑Plans ❑Samples ❑Purchase Order No. ITEM REFERENCE NO.OF TRANSMITTED NO. SECTION NO. COPIES DESCRIPTION AND REFERENCE DATA PER o,DE 1 1 Backflow Preventer Test Report for Serial#K8383 3 TRANSMITTAL CODES: 1. For Acknowledgment 6. Approved as Submitted 2. For Approval 7. Approved as Noted 3. For Your Use 8. Resubmit Copies for Approval 4. As Requested 9. Release for production as per delivery date indicated on our Purchase Order 5. For Review and Comment 10.Furnish changes in contract price,if affected,by 11. Other. REMARKS: tl Copy To: 1. Project Manager File 2. Follow-up File City of Orono Corval Constructors, Inc. Doug 7kachuck/Service W anagen ' 1' VAL UPnnnnkfiw� RECEIVED JUL 3 1201 4 CnY op 1633 Eustis Street, St Paul, Minnesota 55108-1219 (651)645-0451 Fax: (651)642-9QNo An Affirmative Action, Equal Opportunity Employer TO: Justin McCoy DATE: 7/30/14 ISD 278 Orono Schools PROJECT: RPZ Testing 685 Old Crystal Bay Road LOCATION: Orono H.S. &Orono M.S. Orono, MN 55356 OUR PROJECT NO.: 1036 WE ARE SENDING YOU: ®Attached ❑Change Order El Specifications ❑Shop Drawings ❑Under Separate Cover ❑Copy of Letter ❑Prints ❑Request for Change ❑Thru Messenger ❑Plans ❑Samples ❑Purchase Order No. ITEMREFERENCE NO OF; TRANSMITTED ' NO. SECTION NO, COPIES DESCRIPTION AND REFERENCE DATA PER CODE BELOW 1 1 Backflow Preventer Test Report for Serial#501319 3 2 1 Backflow Preventer Test Report for Serial# 143091 3 3 1 Backflow Preventer Test Report for Serial# 143088 3 TRANSMITTAL CODES: 1. For Acknowledgment 6. Approved as Submitted 2. For Approval 7. Approved as Noted 3. For Your Use 8. Resubmit Copies for Approval 4. As Requested 9. Release for production as per delivery date indicated on our Purchase Order 5. For Review and Comment 10.Fumish changes in contract price,if affected,by 11. Other: REMARKS: Copy To: 1. Project Manager File 2. Follow-up File Corval Constructors, Inc. City of Orono Doug 7kachuck/Servke 911anager