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HomeMy WebLinkAboutM_backflow reports_20230314_v1BACKFLOW PREVENTION ASSEMBLY TEST REPORTAACRA Backflow Testing and Repair, Inc. (360) 631-0039 NAME OF PREMISE First Ukrainian Pentecostal ASSEMBLY ID/FILE #/UTILITY DEVICE #Meter # ACCOUNT # ZIP 98056SERVICE ADDRESS 3811 NE 21st St CONTACT PERSON PHONE (206) 861-4351 LOCATION OF ASSEMBLY In vault near entrance to church DOWNSTREAM PROCESS Fire Service MODEL 350ASTDA SERIAL NO.22662B SIZE 6" Commercial Residential APPROVED ASSEMBLY? NO PROPER INSTALLATION? YES NO NEW INSTALL EXISTING REPLACEMENT REMOVED OLD SER.# DCVA RPBA PVBA OTHER DCDA REMARKS: CALIBRATION DATE 12-03-2021 GAUGE #06101237 MODEL Midwest 845- CONFINED SPACE?No CERT. NO.B6423 DATE 8/4/2022 TESTERS NAME PRINTED Joshua Cobb TESTERS PHONE #(360)631-0039 PASSED FAILED PASSED FAILED LEAKED LEAKED LEAKED LEAKED PSID3.0 PSID4.1 PSID PSID OPENED AT #1 CHECK AIR GAP OK? OPENED AT #1 CHECK OPENED AT HELD AT LEAKED CLEANED REPAIRED AIR INLET CHK VALVE INITIAL TEST DCVA / RPBA CHECK VALVE NO.1 DCVA / RPBA RPBA PVBA / SVBA PSID PSID PSID PSID PSID PSID PSID PSID NEW PARTS AND REPAIRS TEST AFTER REPAIRS DID NOT OPEN CHECK VALVECLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE PART AIR INLET AIR GAP INSPECTION: DETECTOR METER READING LEFT SERVICE AS FOUND REPAIRED BY: FINAL TEST BY: DATE DATE TESTERS SIGNATURE: CERT. NO. LINE PRESSURE 55 PSI SERVICE RESTORED YES NO SOV#1:Open Closed SOV#2:Open Closed CHECK VALVE NO.2 Isolation valve:Open Closed YES LIC NO. WATER PURVEYOR Renton Renton CLOSED TIGHT CLOSED TIGHT RV EXERCISEDCLOSED TIGHT CLOSED TIGHT MAKE OF ASSEMBLY Wilkins PASS FAILSUPPLY PIPE DIAMETER SEPARATION I certify that this report is accurate, and I have used WAC 246-290-490 approved test methods and test equipment. BACKFLOW PREVENTION ASSEMBLY TEST REPORTAACRA Backflow Testing and Repair, Inc. (360) 631-0039 NAME OF PREMISE First Ukrainian Pentecostal ASSEMBLY ID/FILE #/UTILITY DEVICE #Meter # ACCOUNT # ZIP 98056SERVICE ADDRESS 3811 NE 21st St CONTACT PERSON PHONE (206) 861-4351 LOCATION OF ASSEMBLY In vault near entrance to church DOWNSTREAM PROCESS Fire Service Bypass MODEL 950XLD SERIAL NO.HC46708 SIZE .75" Commercial Residential APPROVED ASSEMBLY? NO PROPER INSTALLATION? YES NO NEW INSTALL EXISTING REPLACEMENT REMOVED OLD SER.# DCVA RPBA PVBA OTHER REMARKS: CALIBRATION DATE 12-03-2021 GAUGE #06101237 MODEL Midwest 845- CONFINED SPACE?No CERT. NO.B6423 DATE 8/4/2022 TESTERS NAME PRINTED Joshua Cobb TESTERS PHONE #(360)631-0039 PASSED FAILED PASSED FAILED LEAKED LEAKED LEAKED LEAKED PSID0.0 PSID2.2 PSID2.4 PSID2.2 Disc OPENED AT #1 CHECK AIR GAP OK? OPENED AT #1 CHECK OPENED AT HELD AT LEAKED CLEANED REPAIRED AIR INLET CHK VALVE INITIAL TEST DCVA / RPBA CHECK VALVE NO.1 DCVA / RPBA RPBA PVBA / SVBA PSID PSID PSID PSID PSID PSID PSID PSID NEW PARTS AND REPAIRS TEST AFTER REPAIRS DID NOT OPEN CHECK VALVECLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE PART AIR INLET AIR GAP INSPECTION: DETECTOR METER READING LEFT SERVICE AS FOUND REPAIRED BY: FINAL TEST BY: DATE DATE TESTERS SIGNATURE: CERT. NO. LINE PRESSURE 55 PSI SERVICE RESTORED YES NO SOV#1:Open Closed SOV#2:Open Closed CHECK VALVE NO.2 Isolation valve:Open Closed YES LIC NO.Joshua Cobb COBB*JD841OR 08-04-2022 Joshua Cobb B6423 08-04-2022 WATER PURVEYOR Renton Renton CLOSED TIGHT CLOSED TIGHT RV EXERCISEDCLOSED TIGHT CLOSED TIGHT MAKE OF ASSEMBLY Wilkins PASS FAILSUPPLY PIPE DIAMETER SEPARATION I certify that this report is accurate, and I have used WAC 246-290-490 approved test methods and test equipment.