HomeMy WebLinkAboutPermit File BLD-2020-0227 1505 Harbor View Court (5)Affordable Washington Backflow Testing
(360) 863-3784
BACKFLOW PREVENTION ASSEMBLY TEST REPORT
WATER PURVEYOR Anacortes ACCOUNT #
ASSEMBLY ID/FILE #/UTILITY DEVICE # Meter #
NAME OF PREMISE Progressive Design Builders Commercial ❑ Residential W
SERVICE ADDRESS 2718 Geer Lane Anacortes ZIP 98038
CONTACT PERSON Steve Smith PHONE (541) 740-2948
LOCATION OF ASSEMBLY In Box Left side of Foundation Behind Fence
DOWNSTREAM PROCESS Irrigation System DCVA W RPBA ❑ PVBA ❑ OTHER
NEW INSTALL W EXISTING ❑ REPLACEMENT ❑ REMOVED ❑ OLD SERX
APPROVED ASSEMBLY? YES ❑d NO ❑ PROPER INSTALLATION? YES ❑V NO ❑
MAKE OF ASSEMBLY Febco MODEL 850 SERIAL NO. HF54519 SIZE 1"
DCVA / RPBA
DCVA / RPBA
RPBA
PVBA / SVBA
INITIAL
CHECK VALVE NO.1
CHECK VALVE NO.2
AIR INLET
TEST
OPENED AT PSID
CLOSED TIGHT d❑
CLOSED TIGHT ❑�
OPENED AT PSID
PASSED
#1 CHECK PSID
LEAKED ❑
LEAKED ❑
DID NOT OPEN
FAILED ❑
2.2 PSID
2.1 PSID
AIR GAP OK?
CLEAN REPLACE PART
CLEAN REPLACE PART
CLEAN REPLACE PART
CHECK VALVE
NEW
❑ ❑
❑ ❑
❑ U
HELD AT PSID
PARTS
❑ ❑
❑ ❑
❑ ❑
LEAKED ❑
❑ ❑
❑ ❑
❑ F-1
AND
❑ ❑
❑ ❑
❑ ❑
CLEANED ❑
REPAIRS
REPAIRED ❑
TEST AFTER
CLOSED TIGHT ❑
CLOSED TIGHT ❑
RV EXERCISED ❑
AIR INLET PSID
REPAIRS
LEAKED ❑
LEAKED ❑
OPENED AT PSID
PASSED ❑
FAILED ❑
PSID
PSID
#1 CHECK PSID
CHK VALVE PSID
AIR GAP INSPECTION: SUPPLY PIPE DIAMETER SEPARATION PASS ❑ FAIL ❑
DETECTOR METER READING
LEFT SERVICE AS FOUND Isolation valve: Open ❑d Closed ❑ SOV#1: Open ❑d Closed ❑ SOV#2• Open i] Closed ❑
REMARKS:
TESTERS SIGNATURE: "UCD
-LINE PRESSURE 51 PSI CONFINED SPACE? No
CERT. NO. B5134 DATE 8/28/2021
TESTERS NAME PRINTED David Foy TESTERS PHONE # (360)333-2057
REPAIRED BY: LIC NO.
DATE
FINAL TEST BY: CERT. NO. DATE
CALIBRATION DATE 02-26-2021 GAUGE # 03161194 MODEL Midwest 845 SERVICE RESTORED YES 0 NO ❑
I certify that this report is accurate, and I have used WAC 246-290-490 approved test methods and test equipment.
Affordable Washington Backflow Testing
(360) 863-3784
BACKFLOW PREVENTION ASSEMBLY TEST REPORT
WATER PURVEYOR Anacortes ACCOUNT #
ASSEMBLY ID/FILE #/UTILITY DEVICE # Meter #
NAME OF PREMISE Progressive Design Builders Commercial ❑ Residential W
SERVICE ADDRESS 1505 Harbor View Ct Anacortes ZIP 98038
CONTACT PERSON Steve Smith PHONE (541) 740-2948
LOCATION OF ASSEMBLY In Box Right of Entry at Foundation
DOWNSTREAM PROCESS Irrigation System DCVA ke RPBA ❑ PVBA ❑ OTHER
NEW INSTALL W EXISTING ❑ REPLACEMENT ❑ REMOVED ❑ OLD SERX
APPROVED ASSEMBLY? YES ❑d NO ❑ PROPER INSTALLATION? YES ❑V NO ❑
MAKE OF ASSEMBLY Febco MODEL 850 SERIAL NO. HF79009 SIZE 1"
DCVA / RPBA
DCVA / RPBA
RPBA
PVBA / SVBA
INITIAL
CHECK VALVE NO.1
CHECK VALVE NO.2
AIR INLET
TEST
OPENED AT PSID
CLOSED TIGHT d❑
CLOSED TIGHT ❑�
OPENED AT PSID
PASSED
#1 CHECK PSID
LEAKED ❑
LEAKED ❑
DID NOT OPEN
FAILED ❑
2.3 PSID
2.6 PSID
AIR GAP OK?
CLEAN REPLACE PART
CLEAN REPLACE PART
CLEAN REPLACE PART
CHECK VALVE
NEW
❑ ❑
❑ ❑
❑ U
HELD AT PSID
PARTS
❑ ❑
❑ ❑
❑ ❑
LEAKED ❑
❑ ❑
❑ ❑
❑ F-1
AND
❑ ❑
❑ ❑
❑ ❑
CLEANED ❑
REPAIRS
REPAIRED ❑
TEST AFTER
CLOSED TIGHT ❑
CLOSED TIGHT ❑
RV EXERCISED ❑
AIR INLET PSID
REPAIRS
LEAKED ❑
LEAKED ❑
OPENED AT PSID
PASSED ❑
FAILED ❑
PSID
PSID
#1 CHECK PSID
CHK VALVE PSID
AIR GAP INSPECTION: SUPPLY PIPE DIAMETER SEPARATION PASS ❑ FAIL ❑
DETECTOR METER READING
LEFT SERVICE AS FOUND Isolation valve: Open ❑d Closed ❑ SOV#1: Open ❑d Closed ❑ SOV#2• Open i] Closed ❑
REMARKS:
TESTERS SIGNATURE: "UCD
-LINE PRESSURE 100 PSI CONFINED SPACE? No
CERT. NO. B5134 DATE 8/28/2021
TESTERS NAME PRINTED David Foy TESTERS PHONE # (360)333-2057
REPAIRED BY: LIC NO.
DATE
FINAL TEST BY: CERT. NO. DATE
CALIBRATION DATE 02-26-2021 GAUGE # 03161194 MODEL Midwest 845 SERVICE RESTORED YES 0 NO ❑
I certify that this report is accurate, and I have used WAC 246-290-490 approved test methods and test equipment.