HomeMy WebLinkAbout3/27/2002 bfp15nvanburen)WA CITY - PUBLIC DRINKING WATER PROGRAM
ACKFLOW PREVENTION ASSEMBLY TEST DATA AND MAINTENANCE REPORT
~Yl~ OF
-4E~GHT OFF FLOOR
TIME: J~J A.M. ] SUPf~.Y PRESSURE
MANUFACT~FR MOO6L
~OTECTION FROM:
FRE~ING ~YES ~ NO FLOOO[NG ~ES ~ NO
AIR GAP 12 x SUPPLY DIAM )
SUPPLY
s~zE '~/F ~
COMMENTS:
IFILE NUMBER
METER NUMBER
IN. GAP
~PASS
IN r-I FAIL
SERIAL NUMIBER
-7
INEW INSTALLAT~O~
[] YES ~-NO
INITIAL TEST Passe/d Failed
REDUCED PRESSURE PRINCIPAL ASSEMBLY: E~ []
ISTCHECK heldin ~_ j~
direction of flow PSID (5 PSID or more) . []
RELIEF VALVE .~
opened at _ ~ PSID (2 PSID or more) I~ []
DIFFERENCE
(1st check - relief) ~-'~ PSID (3 PSID or more) /1~ ' []
2ND CHECK held backpressure [3'/ []
NO. 2 SHUTOFF VALVE leak tight IZ/ [3
2NDCHECK heldin/ _~..p E~
direction of flow .. SmD (1 PSID or more) []
RELIEF VALVE exercised to full open position []
FINAL TEST AFTER REPAIR Passed Failed
REDUCED PRESSURE PRINCIPAL ASSEMBLY: [] []
1 ST CHECK held in
direction of flow PSID (5 PSID or more) [] []
RELIEF VALVE
opened at PSID (2 PSlD or more) D []
DIFFERENCE
(1st check - relief) PSID (3 PSID or more) [] []
2ND CHECK held backpressure [] []
NO. 2 SHUTOFF VALVE leak tight [] []
2ND CHECK held in
direction of flow PSID (1 PSID or more) [] []
RELIEF VALVE exercised to full open position []
NOTE: Failure of any of the above items, requires repair.
INITIAL TEST Passed Failed
DOUBLE CHECK VALVE ASSEMBLY: [] []
1ST CHECK held in
direction of flow PSID (1 PSID or more) [] []
2ND CHECK held backpressure [] [3
NO. 2 SHUTOFF VALVE leak tight [] []
2ND CHECK held in
direction of flow __ PSID (1 PSID or more) [] []
NOTE: Failure of any ;3f the above items, requires repair.
FINAL TEST AFTER REPAIR Passed Failed
DOUBLE CHECK VALVE ASSEMBLY: [] []
1ST CHECK held in
direction of flow PSID (1 PSID or more) [] []
2ND CHECK held backpressure [] []
NO. 2 SHUTOFF VALVE leak tight [] []
2ND CHECK held in
direction of flow PSID (1 PSID or more) [] []
INITIAL TEST
PRESSURE VACUUM BREAKER: Passed
Internal check held tight in direction of flow
PSID (1 PSID or more) 1:3
Inlet Poppet opened at ~ PSID
(1 PSID or more) []
NOTE: Failure of any of the above items, requires repair.
INITIAL TEST
APPROVED APPUCA TIONS ONLY
Failed
ri
APPROVED APPUCA TIONS ONLY
FINAL TEST AFTER REPAIR
PRESSURE VACUUM BREAKER: Passed Failed
Internal check held tight in direction of flow
PSID (i PSID or more) [3 [3
Inlet Poppet opened at PSID
(1 PSID or more) [3 []
FINAL TEST AFTER REPAIR
ANTI-SPILL VACUUM BREAKER: Passed Failed
Differential pressure across check was
PSID (1 PSID or more) [] ID
Air inlet start to open at __ PSlD
(1 PSID or more) [] []
Air inlet fully open when supply pressure
atmospheric [] []
NOTE: Failure of any of the above items, requires repair.
ANTI-SPILL VACUUM BREAKER: Passed Failed
Differential pressure across check was
PSID (1 PSID or more) [3 []
Air inlet start to open at PSID
(1 PSID or more)
Air inlet fully open when supply pressure
atmospheric []
COMMENTS
REPAIR HISTORY
AI~ID COMPLETE.
THE ABOVE REPORT Ir~S CERTIF'ED TO BE TRUE' ACCURATE yn~u~
Date
;/93 - hisbJg~drinkw~r. Ffrn o~WueUT~O~: w~err~ . wATi~I~ suem.~a; ~'eLLOW · OWN~a; eeac ·
IOWA CITY - PUBLIC DRINKING WATER PROGRAM
BACKFLOW PREVENTION ASSEMBLY TEST DATA AND MAINTENANCE REPORT
SERVICE LOCATION . ~ ~ M~ER NUMBER
· IIN./FT.IFREE~ING I~r YES n NO FLOODING Y[~ES [] NO [] YES [~ NO
INITIAL TEST Passe/d Failed FINAL TEST AFTER REPAIR Passed Failed
REDUCED PRESSURE PRINCIPAL ASSEMBLY:E~' [] REDUCED PRESSURE PRINCIPAL ASSEMBLY: [] []
1ST CHECK held in ~~ 1 ST CHECK held in
direction of flowu PSID (5 PSID or more) ~' [] direction of flow __ PSID (5 PSID or more) []
RELIEF VALVE RELIEF VALVE
opened at~j,f_/3 PSID (2 PSID or more) El/ [] opened at __ PSID (2 PSID or more) El []
DIFFERENCE DIFFERENCE
(1st check - relief) ~-~- PSID (3 PSID or more) I~ [] (1st check - relief) __ PSID (3 PSID or more) [] []
2ND CHECK held backpressure i~ [] 2ND CHECK held backpressure [] []
NO. 2 SHUTOFF VALVE leak tightI~ [] NO. 2 SHUTOFF VALVE leak tight [] []
2ND CHECK held in~ ~ ,¢,~~, 2ND CHECK held in
direction of flow ~.(-- PSID (1 PSID or more)~ [] direction of flow __PSID (1 PSID or more) [] []
RELIEF VALVE exercised to full open position [] RELIEF VALVE exercised to full open position D []
NOTE: Failure of any of the above items, requires repair.
INITIAL TEST Passed Failed FINAL TES'~ A'FTER REPAIR Passed Failed
DOUBLE CHECK VALVE ASSEMBLY: [] [] DOUBLE CHECK VALVE ASSEMBLY: [] []
1 ST CHECK held in 1ST CHECK held in
direction of flow PSID (1 PSID or more) [] [] direction of flow PSID (1 PSID or more) [] []
2ND CHECK held backpressure [] [] 2ND CHECK held backpressure [] []
NO. 2 SHUTOFF VALVE leak tight [] [] NO. 2 SHUTOFF VALVE leak tight [] []
2ND CHECK held in 2ND CHECK held in
direction of flow PSID (1 PSID or more) [] D direction of flow PSID (1 PSID or more) [] []
NOTE: Failure of any of the above items, requires repair.
INITIAL TEST APPROVED APPUCA TIONs ONLY ! FINA'L TEST AFTER REPAIR "
PRESSURE VACUUM BREAKER: Passed Failed PRESSURE VACUUM BREAKER: Passed Failed
Internal check held tight in direction of flow Internal check held tight in direction of flow
PSID (1 PSID or more) [] E! PSID (1 PSID or more) El []
Inlet Poppet opened at~ PSID Inlet Poppet opened at~ PSID
(1 PSID or more) [] n (1 PSID or more) [] []
NOTE: Failure of any of the above items, requires repair.
INITIAL TEST APPROVED APPLICATIONS ONLY FINAL TEe'I; AFTER REPAIR
ANTI-SPILL VACUUM BREAKER: Passed Failed ANTI-SPILL VACUUM BREAKER: Passed Failed
Differential pressure across check was Differential pressure across check was
PSID (1 PSID or more) El [] PSID (1 PSID or more) [] []
Air inlet start to open at ~ PSID Air inlet start to open at __ PSID
(1 PSID or more) [] [] (1 PSID or more) [] []
Air inlet fully open when supply pressure Air inlet fully open when supply pressure
atmospheric [] [] atmospheric [] []
NOTE: Failure of any of the above items, requires repair.
COMMENTS
REPAIR HISTORY
THE ABOVE REPORT IS CERTIFIED TO BE TRUE, ACCURATE AND_COMPLETE,
. · , · 7f
Date
Date
3193 - hisblg\drinkwtr. Frm O~TR~UT~ON: ~ - WATER SUPRMER; YEU.O'~ - OWNER; PINK - TESTER