HomeMy WebLinkAboutRS_Backflow_Test1_Towns on 12th__20250909_v1BACKFLOW PREVENTION ASSEMBLY TEST REPORTA+ Backflow Inc
(425) 830-3749
NAME OF PREMISE 3818
ASSEMBLY ID/FILE #/UTILITY DEVICE #Meter #
ACCOUNT #
ZIP 98056SERVICE ADDRESS 3818 NE 12th St
CONTACT PERSON Misty Finlayson PHONE
LOCATION OF ASSEMBLY 30' From Mailbox Kiosk
DOWNSTREAM PROCESS Irrigation
MODEL 850 SERIAL NO.H847553 SIZE 1"
Commercial Residential
APPROVED ASSEMBLY? NO PROPER INSTALLATION? YES NO
NEW INSTALL EXISTING REPLACEMENT REMOVED OLD SER.#
DCVA RPBA PVBA OTHER
REMARKS:Left Service As Found
CALIBRATION DATE 01-15-2025 GAUGE #12240534 MODEL Midwest 845
CONFINED SPACE?No
CERT. NO.B6074 DATE 7/31/2025
TESTERS NAME PRINTED Dave Kuca TESTERS PHONE #(425)830-3749
PASSED
FAILED
PASSED
FAILED
LEAKED LEAKED
LEAKED LEAKED
PSID2.6 PSID2.0
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 60 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 City of Renton
Renton
CLOSED TIGHT CLOSED TIGHT
RV EXERCISEDCLOSED TIGHT CLOSED TIGHT
MAKE OF ASSEMBLY Febco
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.