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HomeMy WebLinkAbout117_03-28-25BACKFLOW PREVENTION ASSEMBLY TEST REPORTA+ Backflow Inc (425) 830-3749 NAME OF PREMISE 117 ASSEMBLY ID/FILE #/UTILITY DEVICE #Meter # ACCOUNT # ZIP 98057SERVICE ADDRESS 117 Wells Ave S CONTACT PERSON JC Clementz PHONE (206) 779-1414 LOCATION OF ASSEMBLY In Vault, Front of Prop DOWNSTREAM PROCESS Fire Service MODEL 350ASTDA SERIAL NO.36590B SIZE 4" Commercial Residential APPROVED ASSEMBLY? NO PROPER INSTALLATION? YES NO NEW INSTALL EXISTING REPLACEMENT REMOVED OLD SER.# DCVA RPBA PVBA OTHER DCDA REMARKS:Left Service As Found CALIBRATION DATE 03-28-2024 GAUGE #12130810 MODEL Midwest 845 CONFINED SPACE?No CERT. NO.B6074 DATE 3/28/2025 TESTERS NAME PRINTED Dave Kuca TESTERS PHONE #(425)830-3749 PASSED FAILED PASSED FAILED LEAKED LEAKED LEAKED LEAKED PSID3.4 PSID3.8 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 70 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 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 REPORTA+ Backflow Inc (425) 830-3749 NAME OF PREMISE 117 ASSEMBLY ID/FILE #/UTILITY DEVICE #Meter # ACCOUNT # ZIP 98057SERVICE ADDRESS 117 Wells Ave S CONTACT PERSON JC Clementz PHONE (206) 779-1414 LOCATION OF ASSEMBLY At Meter, Front of Prop DOWNSTREAM PROCESS Irrigation MODEL LF007M2QT SERIAL NO.061882 SIZE 1.5" Commercial Residential APPROVED ASSEMBLY? NO PROPER INSTALLATION? YES NO NEW INSTALL EXISTING REPLACEMENT REMOVED OLD SER.# DCVA RPBA PVBA OTHER REMARKS: CALIBRATION DATE 03-28-2024 GAUGE #12130810 MODEL Midwest 845 CONFINED SPACE?No CERT. NO.B6074 DATE 3/28/2025 TESTERS NAME PRINTED Dave Kuca TESTERS PHONE #(425)830-3749 PASSED FAILED PASSED FAILED LEAKED LEAKED LEAKED LEAKED PSID2.0 PSID2.4 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 70 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 Watts 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 REPORTA+ Backflow Inc (425) 830-3749 NAME OF PREMISE 117 ASSEMBLY ID/FILE #/UTILITY DEVICE #Meter # ACCOUNT # ZIP 98057SERVICE ADDRESS 117 Wells Ave S CONTACT PERSON JC Clementz PHONE (206) 779-1414 LOCATION OF ASSEMBLY In Vault, Front of Prop DOWNSTREAM PROCESS Fire Service Bypass MODEL 950XLD SERIAL NO.HC78135 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 03-28-2024 GAUGE #12130810 MODEL Midwest 845 CONFINED SPACE?No CERT. NO.B6074 DATE 3/28/2025 TESTERS NAME PRINTED Dave Kuca TESTERS PHONE #(425)830-3749 PASSED FAILED PASSED FAILED LEAKED LEAKED LEAKED LEAKED PSID2.0 PSID2.4 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 70 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 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.