HomeMy WebLinkAboutPermit File 4603 Cherry Court AACRA Backflow Testing and Repair,Inc. BACKFLOW PREVENTION ASSEMBLY TEST REPORT
(360)631-0039
WATER PURVEYOR Cit\ of Anacortes ACCOUNT#
ASSEMBLY ID/FILE#/UTILITY DEVICE# Meter#
NAME OF PREMISE Cherry Court Commercial ❑ Residential 0
SERVICE ADDRESS 4306 Cherry Ct - Anacortes ZIP 98221
CONTACT PERSON Greg PHONE (360)661-2440
LOCATION OF ASSEMBLY Lot 1. Left prop line
DOWNSTREAM PROCESS Irrigation DCVA ri RPBA ❑ PVBA ❑ OTHER
NEW INSTALL ❑� EXISTING El REPLACEMENT El REMOVED El OLD SER.#
APPROVED ASSEMBLY? YES I NO ❑ PROPER INSTALLATION?YES LI NO ❑
MAKE OF ASSEMBLY Wilkins _ MODEL 350 SERIAL NO. A978313 SIZE 1"
INITIAL DCVA/RPBA DCVA I RPBA RPBA PVBA/SVBA
CHECK VALVE NOJ CHECK VALVE NO.2 AIR INLET
TEST OPENED AT PSID
CLOSED TIGHT El CLOSED TIGHT ✓❑ OPENED AT PSID
PASSED El LEAKED Ili LEAKED ❑ #1 CHECK PSID
FAILED ❑ 2.3 PSID 2.4 PSID AIR GAP OK? DID NOT OPEN ❑
CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE PART CHECK VALVE
NEW ❑ ❑ El ❑ ❑ ❑ - HELD AT _ _. PSID
PARTS ❑ ❑ ❑ ❑ ❑ ❑ LEAKED ❑
❑ ❑ ❑ - . ❑ ❑
AND ❑ ❑ El ❑ ❑ ❑ CLEANED ❑
REPAIRS REPAIRED ❑
TEST AFTER CLOSED TIGHT El CLOSED TIGHT ❑ RV EXERCISED ❑ AIR INLET _ _ PSID
REPAIRS LEAKED ❑ LEAKED ❑ OPENED AT PSID
PASSED ❑
FAILED ❑ PSID PSID #1 CHECK PSID CHIC VALVE PSID
AIR GAP INSPECTION: SUPPLY PIPE DIAMETER _ SEPARATION _ PASS❑ FAIL❑
DETECTOR METER READING
LEFT SERVICE AS FOUND Isolation valve: Open 0 Closed ❑ SOV#1: Open El Closed ❑ SOV#2: Open Closed ❑
REMARKS:
LINE PRF.SSURF 110 PS! CONFINED SPACE? ND
TESTERS SIGNATURE:
4- CERT.NO. B6423 y DATE 10/7/2021
TESTERS NAME PRINTED Joshua Cobb TESTERS PHONE# (360)631-0039
REPAIRED BY: LIC NO. DATE
FINAL TEST BY: CERT. NO. DATE
CALIBRATION DATE 12-15-2020 GAUGE# 12180097 MODEL Midwest 845- SERVICE RESTORED YES {j NO ❑
I certify that this report is accurate,and I have used WAC 246-290490 approved test methods and test equipment.