HomeMy WebLinkAboutbackflow testingBrad Mares
From:
Carmel Backflow <Backflow@carmel.in.gov>
Sent:
Friday, September 20, 2019 1:44 PM
To:
Brad Mares
Subject:
We have received your response for City of Carmel Backflow Test Form
Testers Email
h2obackflow@yahoo.com
Customers Email
Select Tester From List
MILLER, MARK _BF00-1725
Gauge Information
05122609
Phone Number
(317) 626-9441
Calibration Date
12-04-2018
Select Company or Self
Self
Select Service Use
Commercial
Type a question
Unreadable
DEVICE LOCATION
Street name: Randall Drive
ADDRESS
House number: 9745
City: Indianapolis
State: IN
Postal code: 46280
Country: United States
Existing, New or Replacing
Device
New
1
Reason For Replacing,
Removing And/or Other Did not have one
Additional Information
Device Serial Number
4307968
Manufacturer of device
Wilkins
Device Size
1"
Model Number Of Device
975A
Type of protection
Containment
Type Of Service
Domestic
Type a question
Mechanical room
Hazard Code
RP
Passed or Failed
PASS
DC
DC
Check Valve p1 Held At What PISD
Closed Tight ..
._..... _.
Leaked..
Check Valve p2 Held At What PISD:
Closed Tight
.___. ._._...
Leaked...
Date
Time
DC DC
Check Valve p1 Held At What PISD
Closed Tight._ ,
Leaked._ _.
Check Valve #2 Held At What PISD
Closed Tight
Leaked
Date
Time
RP RP
Check Valve #1 Held At What PISD
Closed Tight
Leaked ._._ ........ ,..
Check Valve #2 Held At What PISD
Closed Tight .........
Leaked
Pressure Differential Relief Valve Opened At What PISD
Did NOT Open....... ..
Date
Time
2
RP
RP
Check Valve #2 Held At What PSID
9.8
Closed Tight
Yes
Leaked.........
Check Valve #2 Held At What PSID
Closed Tight
Yes
Leaked
Pressure Differential Relief Valve Opened At What PSID
2.8
Did NOT Open..........
Passed or Failed
PASS
Tagged
YES
Date
09/20/2019 1:30 PM
Time
PVB
PVB
Opened At What PSID
Did NOT Open
__. _..
..... _. ... _...
Did OPEN
Check Valve Held At What PSID
Date
Time
PVB PVB
Opened At What PSID ..__ _.....
Did NOT Open
Did OPEN .__. _.... _...
Check Valve Held At What PSID'.
Date
Time
AIR GAP ONLY Final Test Measured vertical inches above Supply size diameter
Results overflow rim
Air Gap _.
Date
Time
Testers Full Name:. h2obackflow@yahoo.com
Date 09/20/2019 1:40 PM
Time
3