BACKFLOW PREVENTION ASSEMBLY TEST AND ...
Acct # ___________ Inv # ____________ BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT 33055 OR-FILE NO. _________________
NEW INSTALLATION
(FROM NOTIFICATION LETTER)
FIRM NAME : ADMIRAL CONDOS SEATTLE
ADDRESS: 2331 42ND AVE SW
ZIP: 98116
PARTY CONTACTED: Kari Sprecher
883-4955 PHONE NO. (425) _______________
REDUCED PRESSURE BACKFLOW ASSEMBLY AIRGAP (used in lieu of backflow assembly) DOUBLE CHECK VALVE ASSEMBLY PRESSURE VACUUM BREAKER ASSEMBLY
TITLE Management
MAKE OF ASSEMBLY Febco Model 850 Serial No H250812 CROSS-CONNECTION PROTECTED (EX: FIRE SYSTEM, BOILER ETC.) Irragation _________________ garden under large planter LOCATION OF ASSEMBLY Roof ______________________________ Reduced Pressure Assemblies Double Check Assemblies 1st Check 2nd Check Initial Test Repairs And Materials Used Test After Repairs
Closed tight……....
DC-closed tight ■ Leaked………..….. RPpsid
■
Relief Valve Opened at psid
Leaked…………....
2.4
Size 1_________
Pressure Vacuum Breaker Air Inlet Check Valve Opened at psid psid Did not Open………....
Leaked ……..…
2.0
DC-closed tight….. RPpsid
Closed tight……....
Opened at psid
Opened at psid
AirGap Inspected APPROVED
psid
FAILED
Remarks: ______________________________________________ NOTE: This Assembly failed its performance test. It must be repaired, retested, and a complete test report sent to the Seattle Public Utilities within 30 days. Ostrander Initial Test Performed By: Matt ____________
Calibration Date:
10/2/14 ________
RETURN REPORT TO: SEATTLE PUBLIC UTILITIES CSB-INSPECTION SERVICES 700 5TH AVE, SUITE 4900 P.O. BOX 34018 SEATTLE, WA 98124-4018 PHONE 206-684-3536 FAX 206-684-7585
Cert. No.:
Gauge #:
B3902 ___
10071347 ___________
Date:
05/28/2015 12:00pm PDT
845 Model: Midwest _________________
INSPECTED/TESTED BY:
Matt Ostrander
REPAIRED BY FINAL TEST BY
COMPANY PERFORMING TEST: AAA Fire & Safety, Inc 3013 3rd Ave N Seattle, Wa 98109 PH: 206-284-1721 FAX 206-284-2176
5/28/15 DATE: ________
DATE: _____________ DATE: ____________
Acct # ___________ Inv # ____________ BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT 22147 OR-FILE NO. _________________
NEW INSTALLATION
(FROM NOTIFICATION LETTER)
FIRM NAME : ADMIRAL CONDOS SEATTLE
ADDRESS: 2331 42ND AVE SW
ZIP: 98116
PARTY CONTACTED: Kari Sprecher
883-4955 PHONE NO. (425) _______________
REDUCED PRESSURE BACKFLOW ASSEMBLY AIRGAP (used in lieu of backflow assembly) DOUBLE CHECK VALVE ASSEMBLY PRESSURE VACUUM BREAKER ASSEMBLY
TITLE Management
MAKE OF ASSEMBLY Ames Model 2000SS Serial No 120993 CROSS-CONNECTION PROTECTED (EX: FIRE SYSTEM, BOILER ETC.) Fire _________________ room LOCATION OF ASSEMBLY Riser ______________________________ Reduced Pressure Assemblies Double Check Assemblies 1st Check 2nd Check Initial Test Repairs And Materials Used Test After Repairs
Closed tight……....
DC-closed tight ■ Leaked………..….. RPpsid
■
Relief Valve Opened at psid
Leaked…………....
4.0
Size 4"_________
Pressure Vacuum Breaker Air Inlet Check Valve Opened at psid psid Did not Open………....
Leaked ……..…
3.1
DC-closed tight….. RPpsid
Closed tight……....
Opened at psid
Opened at psid
AirGap Inspected APPROVED
psid
FAILED
Remarks: ______________________________________________ NOTE: This Assembly failed its performance test. It must be repaired, retested, and a complete test report sent to the Seattle Public Utilities within 30 days. Ostrander Initial Test Performed By: Matt ____________
Calibration Date:
10/2/14 ________
RETURN REPORT TO: SEATTLE PUBLIC UTILITIES CSB-INSPECTION SERVICES 700 5TH AVE, SUITE 4900 P.O. BOX 34018 SEATTLE, WA 98124-4018 PHONE 206-684-3536 FAX 206-684-7585
Cert. No.:
Gauge #:
B3902 ___
10071347 ___________
Date:
05/28/2015 12:00pm PDT
845 Model: Midwest _________________
INSPECTED/TESTED BY:
Matt Ostrander
REPAIRED BY FINAL TEST BY
COMPANY PERFORMING TEST: AAA Fire & Safety, Inc 3013 3rd Ave N Seattle, Wa 98109 PH: 206-284-1721 FAX 206-284-2176
5/28/15 DATE: ________
DATE: _____________ DATE: ____________
Acct # ___________ Inv # ____________ BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT 18055 OR-FILE NO. _________________
NEW INSTALLATION
(FROM NOTIFICATION LETTER)
FIRM NAME : ADMIRAL CONDOS SEATTLE
ADDRESS: 2331 42ND AVE SW
ZIP: 98116
PARTY CONTACTED: Kari Sprecher
883-4955 PHONE NO. (425) _______________
REDUCED PRESSURE BACKFLOW ASSEMBLY AIRGAP (used in lieu of backflow assembly) DOUBLE CHECK VALVE ASSEMBLY PRESSURE VACUUM BREAKER ASSEMBLY
TITLE Management
MAKE OF ASSEMBLY Wilkins Model 950 Serial No A16298 CROSS-CONNECTION PROTECTED (EX: FIRE SYSTEM, BOILER ETC.) Domestic _________________ room LOCATION OF ASSEMBLY Riser ______________________________ Reduced Pressure Assemblies Double Check Assemblies 1st Check 2nd Check Initial Test Repairs And Materials Used Test After Repairs
Closed tight……....
DC-closed tight ■ Leaked………..….. RPpsid
■
Relief Valve Opened at psid
Leaked…………....
2.8
Size 3"_________
Pressure Vacuum Breaker Air Inlet Check Valve Opened at psid psid Did not Open………....
Leaked ……..…
3.1
DC-closed tight….. RPpsid
Closed tight……....
Opened at psid
Opened at psid
AirGap Inspected APPROVED
psid
FAILED
Remarks: ______________________________________________ NOTE: This Assembly failed its performance test. It must be repaired, retested, and a complete test report sent to the Seattle Public Utilities within 30 days. Ostrander Initial Test Performed By: Matt ____________
Calibration Date:
10/2/14 ________
RETURN REPORT TO: SEATTLE PUBLIC UTILITIES CSB-INSPECTION SERVICES 700 5TH AVE, SUITE 4900 P.O. BOX 34018 SEATTLE, WA 98124-4018 PHONE 206-684-3536 FAX 206-684-7585
Cert. No.:
Gauge #:
B3902 ___
10071347 ___________
Date:
05/28/2015 12:00pm PDT
846 Model: Midwest _________________
INSPECTED/TESTED BY:
Matt 0strander
REPAIRED BY FINAL TEST BY
COMPANY PERFORMING TEST: AAA Fire & Safety, Inc 3013 3rd Ave N Seattle, Wa 98109 PH: 206-284-1721 FAX 206-284-2176
5/28/15 DATE: ________
DATE: _____________ DATE: ____________
Acct # ___________ Inv # ____________ BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT 18056 OR-FILE NO. _________________
NEW INSTALLATION
(FROM NOTIFICATION LETTER)
FIRM NAME : ADMIRAL CONDOS SEATTLE
ADDRESS: 2331 42ND AVE SW
ZIP: 98116
PARTY CONTACTED: Kari Sprecher
883-4955 PHONE NO. (425) _______________
REDUCED PRESSURE BACKFLOW ASSEMBLY AIRGAP (used in lieu of backflow assembly) DOUBLE CHECK VALVE ASSEMBLY PRESSURE VACUUM BREAKER ASSEMBLY
TITLE Management
MAKE OF ASSEMBLY Febco Model 850 Serial No HC38770 CROSS-CONNECTION PROTECTED (EX: FIRE SYSTEM, BOILER ETC.) Irrigation _________________ room LOCATION OF ASSEMBLY Riser ______________________________ Reduced Pressure Assemblies Double Check Assemblies 1st Check 2nd Check Initial Test Repairs And Materials Used Test After Repairs
Closed tight……....
DC-closed tight ■ Leaked………..….. RPpsid
■
Relief Valve Opened at psid
Leaked…………....
2.1
Size 3/4" _________
Pressure Vacuum Breaker Air Inlet Check Valve Opened at psid psid Did not Open………....
Leaked ……..…
1.7
DC-closed tight….. RPpsid
Closed tight……....
Opened at psid
Opened at psid
AirGap Inspected APPROVED
psid
FAILED
Remarks: ______________________________________________ NOTE: This Assembly failed its performance test. It must be repaired, retested, and a complete test report sent to the Seattle Public Utilities within 30 days. Ostrander Initial Test Performed By: Matt ____________
Calibration Date:
10/2/14 ________
RETURN REPORT TO: SEATTLE PUBLIC UTILITIES CSB-INSPECTION SERVICES 700 5TH AVE, SUITE 4900 P.O. BOX 34018 SEATTLE, WA 98124-4018 PHONE 206-684-3536 FAX 206-684-7585
Cert. No.:
Gauge #:
B3902 ___
10071347 ___________
Date:
05/28/2015 12:00pm PDT
845 Model: Midwest _________________
INSPECTED/TESTED BY:
Midwest 845
REPAIRED BY FINAL TEST BY
COMPANY PERFORMING TEST: AAA Fire & Safety, Inc 3013 3rd Ave N Seattle, Wa 98109 PH: 206-284-1721 FAX 206-284-2176
5/28/15 DATE: ________
DATE: _____________ DATE: ____________
NEW INSTALLATION
(FROM NOTIFICATION LETTER)
FIRM NAME : ADMIRAL CONDOS SEATTLE
ADDRESS: 2331 42ND AVE SW
ZIP: 98116
PARTY CONTACTED: Kari Sprecher
883-4955 PHONE NO. (425) _______________
REDUCED PRESSURE BACKFLOW ASSEMBLY AIRGAP (used in lieu of backflow assembly) DOUBLE CHECK VALVE ASSEMBLY PRESSURE VACUUM BREAKER ASSEMBLY
TITLE Management
MAKE OF ASSEMBLY Febco Model 850 Serial No H250812 CROSS-CONNECTION PROTECTED (EX: FIRE SYSTEM, BOILER ETC.) Irragation _________________ garden under large planter LOCATION OF ASSEMBLY Roof ______________________________ Reduced Pressure Assemblies Double Check Assemblies 1st Check 2nd Check Initial Test Repairs And Materials Used Test After Repairs
Closed tight……....
DC-closed tight ■ Leaked………..….. RPpsid
■
Relief Valve Opened at psid
Leaked…………....
2.4
Size 1_________
Pressure Vacuum Breaker Air Inlet Check Valve Opened at psid psid Did not Open………....
Leaked ……..…
2.0
DC-closed tight….. RPpsid
Closed tight……....
Opened at psid
Opened at psid
AirGap Inspected APPROVED
psid
FAILED
Remarks: ______________________________________________ NOTE: This Assembly failed its performance test. It must be repaired, retested, and a complete test report sent to the Seattle Public Utilities within 30 days. Ostrander Initial Test Performed By: Matt ____________
Calibration Date:
10/2/14 ________
RETURN REPORT TO: SEATTLE PUBLIC UTILITIES CSB-INSPECTION SERVICES 700 5TH AVE, SUITE 4900 P.O. BOX 34018 SEATTLE, WA 98124-4018 PHONE 206-684-3536 FAX 206-684-7585
Cert. No.:
Gauge #:
B3902 ___
10071347 ___________
Date:
05/28/2015 12:00pm PDT
845 Model: Midwest _________________
INSPECTED/TESTED BY:
Matt Ostrander
REPAIRED BY FINAL TEST BY
COMPANY PERFORMING TEST: AAA Fire & Safety, Inc 3013 3rd Ave N Seattle, Wa 98109 PH: 206-284-1721 FAX 206-284-2176
5/28/15 DATE: ________
DATE: _____________ DATE: ____________
Acct # ___________ Inv # ____________ BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT 22147 OR-FILE NO. _________________
NEW INSTALLATION
(FROM NOTIFICATION LETTER)
FIRM NAME : ADMIRAL CONDOS SEATTLE
ADDRESS: 2331 42ND AVE SW
ZIP: 98116
PARTY CONTACTED: Kari Sprecher
883-4955 PHONE NO. (425) _______________
REDUCED PRESSURE BACKFLOW ASSEMBLY AIRGAP (used in lieu of backflow assembly) DOUBLE CHECK VALVE ASSEMBLY PRESSURE VACUUM BREAKER ASSEMBLY
TITLE Management
MAKE OF ASSEMBLY Ames Model 2000SS Serial No 120993 CROSS-CONNECTION PROTECTED (EX: FIRE SYSTEM, BOILER ETC.) Fire _________________ room LOCATION OF ASSEMBLY Riser ______________________________ Reduced Pressure Assemblies Double Check Assemblies 1st Check 2nd Check Initial Test Repairs And Materials Used Test After Repairs
Closed tight……....
DC-closed tight ■ Leaked………..….. RPpsid
■
Relief Valve Opened at psid
Leaked…………....
4.0
Size 4"_________
Pressure Vacuum Breaker Air Inlet Check Valve Opened at psid psid Did not Open………....
Leaked ……..…
3.1
DC-closed tight….. RPpsid
Closed tight……....
Opened at psid
Opened at psid
AirGap Inspected APPROVED
psid
FAILED
Remarks: ______________________________________________ NOTE: This Assembly failed its performance test. It must be repaired, retested, and a complete test report sent to the Seattle Public Utilities within 30 days. Ostrander Initial Test Performed By: Matt ____________
Calibration Date:
10/2/14 ________
RETURN REPORT TO: SEATTLE PUBLIC UTILITIES CSB-INSPECTION SERVICES 700 5TH AVE, SUITE 4900 P.O. BOX 34018 SEATTLE, WA 98124-4018 PHONE 206-684-3536 FAX 206-684-7585
Cert. No.:
Gauge #:
B3902 ___
10071347 ___________
Date:
05/28/2015 12:00pm PDT
845 Model: Midwest _________________
INSPECTED/TESTED BY:
Matt Ostrander
REPAIRED BY FINAL TEST BY
COMPANY PERFORMING TEST: AAA Fire & Safety, Inc 3013 3rd Ave N Seattle, Wa 98109 PH: 206-284-1721 FAX 206-284-2176
5/28/15 DATE: ________
DATE: _____________ DATE: ____________
Acct # ___________ Inv # ____________ BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT 18055 OR-FILE NO. _________________
NEW INSTALLATION
(FROM NOTIFICATION LETTER)
FIRM NAME : ADMIRAL CONDOS SEATTLE
ADDRESS: 2331 42ND AVE SW
ZIP: 98116
PARTY CONTACTED: Kari Sprecher
883-4955 PHONE NO. (425) _______________
REDUCED PRESSURE BACKFLOW ASSEMBLY AIRGAP (used in lieu of backflow assembly) DOUBLE CHECK VALVE ASSEMBLY PRESSURE VACUUM BREAKER ASSEMBLY
TITLE Management
MAKE OF ASSEMBLY Wilkins Model 950 Serial No A16298 CROSS-CONNECTION PROTECTED (EX: FIRE SYSTEM, BOILER ETC.) Domestic _________________ room LOCATION OF ASSEMBLY Riser ______________________________ Reduced Pressure Assemblies Double Check Assemblies 1st Check 2nd Check Initial Test Repairs And Materials Used Test After Repairs
Closed tight……....
DC-closed tight ■ Leaked………..….. RPpsid
■
Relief Valve Opened at psid
Leaked…………....
2.8
Size 3"_________
Pressure Vacuum Breaker Air Inlet Check Valve Opened at psid psid Did not Open………....
Leaked ……..…
3.1
DC-closed tight….. RPpsid
Closed tight……....
Opened at psid
Opened at psid
AirGap Inspected APPROVED
psid
FAILED
Remarks: ______________________________________________ NOTE: This Assembly failed its performance test. It must be repaired, retested, and a complete test report sent to the Seattle Public Utilities within 30 days. Ostrander Initial Test Performed By: Matt ____________
Calibration Date:
10/2/14 ________
RETURN REPORT TO: SEATTLE PUBLIC UTILITIES CSB-INSPECTION SERVICES 700 5TH AVE, SUITE 4900 P.O. BOX 34018 SEATTLE, WA 98124-4018 PHONE 206-684-3536 FAX 206-684-7585
Cert. No.:
Gauge #:
B3902 ___
10071347 ___________
Date:
05/28/2015 12:00pm PDT
846 Model: Midwest _________________
INSPECTED/TESTED BY:
Matt 0strander
REPAIRED BY FINAL TEST BY
COMPANY PERFORMING TEST: AAA Fire & Safety, Inc 3013 3rd Ave N Seattle, Wa 98109 PH: 206-284-1721 FAX 206-284-2176
5/28/15 DATE: ________
DATE: _____________ DATE: ____________
Acct # ___________ Inv # ____________ BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT 18056 OR-FILE NO. _________________
NEW INSTALLATION
(FROM NOTIFICATION LETTER)
FIRM NAME : ADMIRAL CONDOS SEATTLE
ADDRESS: 2331 42ND AVE SW
ZIP: 98116
PARTY CONTACTED: Kari Sprecher
883-4955 PHONE NO. (425) _______________
REDUCED PRESSURE BACKFLOW ASSEMBLY AIRGAP (used in lieu of backflow assembly) DOUBLE CHECK VALVE ASSEMBLY PRESSURE VACUUM BREAKER ASSEMBLY
TITLE Management
MAKE OF ASSEMBLY Febco Model 850 Serial No HC38770 CROSS-CONNECTION PROTECTED (EX: FIRE SYSTEM, BOILER ETC.) Irrigation _________________ room LOCATION OF ASSEMBLY Riser ______________________________ Reduced Pressure Assemblies Double Check Assemblies 1st Check 2nd Check Initial Test Repairs And Materials Used Test After Repairs
Closed tight……....
DC-closed tight ■ Leaked………..….. RPpsid
■
Relief Valve Opened at psid
Leaked…………....
2.1
Size 3/4" _________
Pressure Vacuum Breaker Air Inlet Check Valve Opened at psid psid Did not Open………....
Leaked ……..…
1.7
DC-closed tight….. RPpsid
Closed tight……....
Opened at psid
Opened at psid
AirGap Inspected APPROVED
psid
FAILED
Remarks: ______________________________________________ NOTE: This Assembly failed its performance test. It must be repaired, retested, and a complete test report sent to the Seattle Public Utilities within 30 days. Ostrander Initial Test Performed By: Matt ____________
Calibration Date:
10/2/14 ________
RETURN REPORT TO: SEATTLE PUBLIC UTILITIES CSB-INSPECTION SERVICES 700 5TH AVE, SUITE 4900 P.O. BOX 34018 SEATTLE, WA 98124-4018 PHONE 206-684-3536 FAX 206-684-7585
Cert. No.:
Gauge #:
B3902 ___
10071347 ___________
Date:
05/28/2015 12:00pm PDT
845 Model: Midwest _________________
INSPECTED/TESTED BY:
Midwest 845
REPAIRED BY FINAL TEST BY
COMPANY PERFORMING TEST: AAA Fire & Safety, Inc 3013 3rd Ave N Seattle, Wa 98109 PH: 206-284-1721 FAX 206-284-2176
5/28/15 DATE: ________
DATE: _____________ DATE: ____________
