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Home My WebLink AboutParkwood VII 280 E 96th St Backflow 8-5-19Sysfems ��rvice� � ' . )`71`) DI AItLING'PON AV� INU]_ANAPOLIS� IN 5�Ci218-:131"L �� a�� 31'//547.-1800 ]�? ;. Tech � _ 01PARII)00 Sales Tax = Oi,000% °°� 50343ti990 6 INVOICE TO: SERVICE LOCATION: PARKIVOOD CROSSING INVESTORS PARK\I�OOD VII PL1Pll�D007 C/O SCP MANAGEMENT, LLC 2II0 E 96TH ST G00 E 96TH ST STE 150 �ME-IFD� (3)UOn1ESTIC q'r`J34��151(1.5"P�IJTHOUSE) ,N980S95(2°RISER RM) ;�980890O"RISGP. RM) NEW SNITCH BOARD S19-1SSti 'PO C'AI,L FOIt SF,RVTCE CON'I'ACTt 'PHAll 3J.7-535-56.15 damian.rollOam,jll,com (C11'I7E;NS WATER) F,MAIL 01?0 PO = P.enewal 09/30/2,019 317/80f3-ti372- JULY HACKFIAW PREVENTOP. S�RV 8emi�Annual 4' Lle ns F unJ (��e�I4�� h�°�S�IS) ��yMS�� I�� Jelvt T h clans 5 ceZ Pori IT valHrs � � � P h � b��J �tlQ�y'Z�� — , l� � O � �:� , Du � tl !� '.. ��P7L . . .. . . _ i TypeofSysten Ma t t re ' 71 � 4 T�ouble Cell ��,��U4� �� - �(�Raullnelns0oollon CompanyName Last SeMce Date Tha ahove inspaclion Is made for the purpose of checkh�g Ihe mechanical andlor eleclrical operalion of Ihe oquipmant and not b �'� �� de�ermine or guarantee proper capacily, enylneerin5� ororiginal Installalion. Vendor shall nal be respons ble For Ihe improNer oUerallon of any insper.fed equlpment Ihat, aNer serviwman has left premises, T�� hasbeendlscharged,vandalized,tamperedvnihordamaged, Leb Hrs. Tha reverse of this agreemenl is fncorpore(ed herein Please reaA r,arefully Wa aro not nn insurer Our maxlmum Ilebilily is Tolal � I mited lo $250.00. User ncknowlede�es rece pt o(copy and ihat he hes re ayd i tlersl nOs reverss e of ac�reemAnL Ma(erial '�_ . _. . _ . �_ �� 1� �_. �.�� _ . Sub-Total ��e N m J�L�'(/Y�;S,J,(�/'14� _ rtee in3 BILLING DEPARTMGNT Usad �`� ��') IEach IAmount f Dale ITechnici�n IHis, IRate ILaborChargo ��, � ,.. . .: . .: , , .., . - - r _ - Cust�� .�5� �.�dR �i'q"'er _. ._7.2i1 '��-, :;. .'=� P� �� " �i��l ' �Q��1 4, Locatiu of e4ice � n �aJ4� 6.Typeafs Nice Domestic II. Type o protecfian ❑ Isolation �ay star ent liom LI Fire ❑ Irrigailon U(I Containment �(�pz�r 5. Is the devlce a new assembly? ❑ Yes No �lacing serlal nurti6er: 7. Ty e of assembly RP ❑ DC ❑ pV6 ❑ SVB ❑ Ah� Gap ❑ AVH 9. e ial numbcr gf device of Meter# Date ��y PASS ❑ FAIL Final Date pnm�dcyr): _ Tima _ ❑ PASS ❑ FAIL 11R GAP 15. Initial qfl. Tel�� Tester 31l 20. Te_ 061 Flnal Tester � oi tes�er 25. Signature and Opened at_ Opaned at_ PSI� PSID � pj�{ Not Open ❑ Did Not Open Che.ck Valve Held PSID I�i i. t,ompany name oltestFf pt � I<oorsen Fire & Securit! n number akester I3F18-61fl2 29. Testing equipment calibratlon date (mrn/dtl/yy 08/06/19 23. Company name of tester (if+ n numhor of testar 27. Testing eyuipment callbra{ion date (mm/dd/yy) Check Valve #1 Held at "e� PSi� �bsed Tight (� aaked Held at__ PSIf] ❑ Closed Tight ❑ Leaked Check Valve #2 Pressure �ifferenlial Air Inlet Relief Valve Held at PSID Opened at �`�0 Opened at _ PSID � PSIQ Glosed Tight ❑ Did Not Open Leaked ❑ �Id Not Open Chedc Valve Neld _., P51� Hcid at_ PSID ❑ Closed Tight ❑ Leal<ed inchos above � �,/] 6y siynin,y th is backFlow 4est report and checicing this box, I berepy cerfify that I am Pami Ilar wifh fhe infomtation contained in fhis Eorm and fhaf fo fhe 6esE otlny knowledge and 6ellef, such infotmafion is true, comp[cte and accuraCe a4 fhe time of fhe 4esC Paye 2 uf 2 From: Sent: To: Subject: Carmel eackflow <Backflow@carmel.in.gow Tuesday, August 6, 2019 10:14 AM Marci Busick We have received your response for City of Carmel Bacl<flow Test Forin Testers Email If Tester is not on Che ch•op down list please add their infoz•mation below Indiana State Ceitiiication Number Gauge Infoimation Phone NumUer Calibration Datc Select Company or Se1f Company Na�ne Tcsling For Phone Number marci.busick ct kooisen.com RiJSTY CARROLL BF1S_61820 06101226 (317)5421800 08-06-2019 Company Koorscn (317) 542-1800 i E1C.�(�l'ESS Select Seivice Use MANAGER NAN1E or C'OMM�RCIAL CUS'1'OMER NAME Type a question llEVICE LOCATION ADDRES5 Exisiing, New or Replacin� Device Device Ser7al Number Manufacturer of device Device Size Model Number Of Device Type of protection Type Of Service Tppe a question Hazud Code Passed or Failed DC Dafe Tiine pr Street Address: 27 ( 9 N Arliugton Ave City: Indianapolis State / Yrovince: IN Posfal / Zip Code: 46218 Couunercial Parkwood VII N/A Slreet name: �ast 96t1i Sh�eet House nun�ber: 280 City: Indianapolis Stale; IN Postal code: 46240 Country: United States Existing 93�4451 Wilkins 1.5 975XL Contauunent Doinestic PENTHOUSE RP PASS ' ce��i� vniv� n� xein n� w�ai risn ; �'�. Closed'1'igl�t . ' Leplced I ��. Cl�ecl� Val��c H2liei� Af R'hnt I'I.SD : ��"�, CloscJ Tighf ��': I.ealeeJ I CheM< VNve pl }leld Af W Iwt PTSD i Clased Tiglil vc vc 2 ]�atC Time RP Date 'I'ime � Passed or Failed T'agged Date Tlme 1�UB llc1tC Time YVB I.enlced CLcck Valre H2 Held A1 Nlmt PISD t Close�'figl�t . . Lealccd CLecle VniveH1 xela Af \Yhal P[SD Clased Tiglif Leniced Cheelc Valre W2 13e1d �1t {V hat I�ISD Closc� Tigh� I.enleetl Pressure Diffcrcnfixl Relief V�Ive Opened A[ R'linf P�SP Did IVOT O��en Cl�eclt Vah�e Nl Hcid At W hnt PSll1 Closetl 7'igLl � Lcalie� Checl< Valve H2lteld At �Yhn� PSIll cros�a r�si�i LcalceU A�rssurcDifferenllnlRcliePVNvc OpenedAtR'hnlPSlll : . Dld NOT Open PASS YrS 08/OS/2019 4:00 PM PV6 '': Opened At �Vlint PSIll . ' Did NOT Open �� : Uld OPEI�' �� . Chedc Vnlve Hcld AI W ��t YSID ��: I'VIS opo�ea ai wi�n� esro 3 itr RP 6.9 YfiS : N� YES NO 36 llid NO'1' OPen Aate Time AIR GAl' ONLY Final Test Results DfltC 'l�ime Tcslers Full Name: DTte Time DiU OPII\ Cliecic Vnlve Hcl�l At R'oa1 PS1D . �. �i�.�:��rea,�e��a��n�.� ��. �no,�� o,-��no,v d�� AlrCay' MARCI BUSICK 08/06/2019 10:10 AM s�nnq� s�� a��,��i�•�� s°,�. L � i.. ��a,_. , t...� / 1 I •� ! • � � / : � ". Customer an�D'euiceal 4or ation - � 4, L.acatia,p of dcy'ce (and addross ifdiljer��t from cu �CSl��w� /✓��`d� 6.7'ype of se ice omesfir. [I Fire ❑ Irdgaiion S. Type f proter.tion ❑ Isolatlon ❑ Containment -- - -- _ ..-.- 10. Size of device 11, Manufacture� of deVice ��L`� I W i�l�in�^� 13, Additional informafion (opfionelJ Meter�' iJl �CAL��.:L/J!'i� Chec;c Valve #1 InitPal .1^7,I(� �,,?7 �ate �m�,✓dayy�: Held atu PSID Time['�,Ll��l�,1 closed'1'ight �pASS Leaked FAIL Final Date � mia,yy�: _ Held at _ PSID Time: ❑ Closed Tiyhf ❑ PASS � Lea(<ed n FAIL AIR GAP Measured vertical inchos above overilow rim : 15. Camments � Initiai �g �elephnnenumber 19. Sign� Tcster 317-542-1800 20. Testing equipmeni serial number 06101226 22, Name and e-mail address of tester Final 24. Telephone nwn�er 25. Si2n+ Tesfer i�)� 'S_'n./LS�CrS `i(u'�I,(i) �- -- 5. Is the device a new asseinbly7 ❑ Yes � o Replacing serial nurnber__ _ 7. T p of aesemhly [�RP ❑ DC ❑ PVB ❑ SV6 ❑ Air Gap ❑ AV6 9. Seri�al nwn6e � o device ' �i�lr�5s�� Check ValveiF2 Pressure Oifferentlal Airinlet Relief Valve Held at _ PSID Opened af Z`7 Opened at _ PSID �5�� ❑ �id Not O en �Closed Tigfit P Leaked ❑ Did Nof Oped Cheak VaWe Held_ PSID Held a�_ PSIU Opened ai_ Opened at_ P51❑ PSIU ❑ qosed Tight ❑ Oid Noi Open ❑ Leaked ❑ �id Not Open chedc Valve Held PSID �._.��_...._...__. .v�__�... .-t ..AVC3 ��--- - 3uppiy size diameter. _ I Ooened tullv7 I-1 Yes I I No name oi �II'0& it cali6rution dete (mm/dc Company name of tester and 27. �� By signing this 6acicflow fest reporf and checicing fhis box, i 6ereUy certify thafi I am familiarwifh Phe infonnaiion contained in fhis form aod thaS 4o Yhe Uest oF my tmowletlge and betief, such inPorcnation is true, complete and accupafe a4 fhe Yime aFthe ipst Paye 2 af 2 From: Sent: To: Subject: Cannel Backflow <BackFlow<�?carmel.in.gov> Tuesday, August 6, 10"19 10;17 AM Marci Busick We have rereived your response for City of Carmel BackFlow Test Form T'esters Emul Lf Tester is not on the drop down list please add their information below India�ia State Certification Numbcr Gauge Information Phone Nu��ber Calibration Date Select Company or ScLf Coinpany Name Testing For Phone NumUei marci. busick@ko oi sen, com Rusty Can•oll BF18_61820 06101226 (317)5421800 os-o6-zor� Company Koarsen (317) 542-1800 ri Address Select Seivice Use MANAGF,IZ NAIvIE or COMMERCIAL CUSTOIvICR NAME Type a question llEV10E LOCATION ADDR�SS Existiug, New or Replacictg Device Device Serial NuutUer Manu£acturer of device Devicc Size Nfodel Number Of Device Type ofproteclim� 1'ype Of' Service Type a question Hazard Code Passed or railed DC. Dilte Time DC Street Acldt'ess: 2719 N Aa'lington Ave City: T�idianapolis State / Province: IN Postal / Zip Code: 46218 Canmercial Paz�l<wood VII 4�4947496 Street uame: East 96Yh Street Hause number: 280 City:ludianapolis State: IN Postal code: 46240 Coiiuhy: UniCed States �xisting 980890 Wilkins 1.5 975XL Contaimnent Domestic 1tTSER ROOM RP YAS5 :' Chec1[ Valve t!I Ileid �11 {PIInI PISD ': CloscJ'1'iRht Lealretl CI�ecle Yalve N2 HeW A1 W hat YISll ; Cioscd Tighf ' I,enlicJ � Cliccic Vxlvc Hl I3cld AI 1Vlial PTSD "�, CloseU Tiglit nc llC 2 Date Time RP Date Time RP Passed or Failed Tagged Date Time PVB Date 'I'ime PVB Lcnlud . Check V»I��c q2 Hcld A1 {VLnt PiSD �� ClaSeilTi�h1 '�.. Lenlmd Cl�ecle \'nlre/ll Reld AI11'Ilnl YISD Closed'fi};hl Lenlcc� CI�cclt Valvc U211e1� d� 1VI��1 PISD Closc� Tight Lcelcc0 Prevure Diffcreufinl Relief Vnlve Opened At 1Vh;�t 1'ISD ��- Di� NOT Open ��. i� av ChecicVnlveNtHeldAtWhnIPSID : 93 - Cfoscd 1'ight �; yes � Leal�e� ��. no Chccic Vnlrc 112 ilald At WhatPSID : Closed'1'ight yes . LeniteU no �PressnreDifferenfiolReliefValvcOpcucAAt\Vhn1YSN'i 2.5 � Did NOT Opcu PASS YES OS/OS/2019 3:50 PM i Openetl At �Vhqt PSID '. Did NO'CdPmi .. . I D(d OP�N : Checl< C'alve Held At Nhat PSID � rvn rvx '�: op��eci nnvi,�rrsm �.: 3 uid nor on<�� DBtB Time ATR GAP ONLY Final Test Results Date 1'inte Testeis Full Name: Date Time n�a orrn CLecic {�nlve Hcld At Nl�nl PSID' a��.s��i ve� r��i i��i�es �. xouvc ovcrno�v r�m n�, c�n, Marci Busicl< 08lOG/2019 10:10 AM s�„�ir si:� m:��m� :�`'�t; :� .. a . ,: ,: ., .: . — - _ (%Us�in?�ndlDe�i'e„�f"�9��lation ;;; � - � c , � / / . ', Checic Valve �f1 Held at V � 'PSID Llj},Glosed Tight j]teaked � Doineslic ❑ Fire ❑ Irri�afion 8. Type of protedion ❑ Isolafion �Containmenl 10.SIzeo(d,evice 11.Manufaplprerofdevice Meterif 6�0'� (g��?�Z Initial //� Oate ��✓vdyy�: U Tlme: ��S ❑ pASS Final Date �mm�amyyy ^ Held at ^ PSID 71me: ❑ Closed Tlght ❑ PASS � Leaked ❑ FAIL AIR GAP ��. -�- __ Measuted vertical inches above overFlow r1im : '15. Commenls �� I ( (�I�Rr Vo\J2 Initial Tesfer 22. Final ?4. Tester Carroll if different of �a r5 �. is ihe device a new asseinbly7 LJ Yes � No _ �lacii� serial number 7. T �c o( assembly �;RP ❑ DC ❑ PVB. _0 SVB ❑ Air Gap ❑ AVB 9. enai number of device �� q� � ��I� Check Valve �k7_ Pressure Differenlial Air Inlet RelieF Valve Held at _ PSID Opened at l S Opened at _ PSID �Closed Tight ps�� ❑ �id Nu1 Open Leaked ❑ �Id Not Open Check Valve Held PSID Neld at � PSID Opened at _ Opened at _ PSIU PSID � pid Not O en ❑ Closed Tight P ❑ Leaked ❑ Did Not Open Check Valve Held P51� ��.t,� �Jl\JW 7.� e-mail address oF tester number 25. SignaWre name o Fire & � — 23. Company name of tester (if I26. Testing equipment sedal num6er I 27. Testing equipmenf calibration dato (mm/dd/yy) [f] By slgning this hacfcflow test reporF and checking fhis box, I herehy ceHify tha41 am familiarwifh fhe information r,ontained in fhis form and thaf to the besf oFmy Imowledge and belief, such infoRnation is Yrue, complete and accurafe aE the Yime oFthe test. Page 2 of 2 Nlarci Busick From: Carmel Bad<flow <Backflow@cannel.in.yov> Sent: Tuesday, August 6, 2019 10:19 AM To: Marci Busick Subject: We have received your response for City of Carmel Backflow Tesf Form Testers Smail If Tester is not on the drop down list please add Yheir information UeIow Indiana Stata Cei�tiflcltion Nwnber Gauge inforniation Yhone NumUer Calibration Date Select Company or Self Company Name Testing For Phoue Ntunber marci.busick@koorseu, com Rusty Carroll BF18_61820 06101226 (317) 5�21800 08-06-2019 Coinpany Koorsen (317)542-1800 Address Select Seivice Use MANAGF,R NAMr or COivIM�RCIAL CUSTOM�R NAME 1'ype a queslion DEVICE LOCATION ADDR�SS Exisfing, New or Replacing Device Device Serial Number Manufacturex• of device Device 5ize Model NumbeA Of Device Type of protection Type Of Service Type a question Hazard Code Passed or Pailcd DC Daie "I'ime DC Street Address: 2719 N l�luigton Ave City: Indianapolis Stale / Province:IN Postal / Zip Code: 46218 Commercial Parkwood VII 40206432 Stteet nau�e; East 96th Street House iminUer: 2�i0 City: Iudi2napolis State: LN Postal code: 46240 Cotmtry: United States Existiug 980895 Wilkins I.5 975XL ConYainment Domesric RIS�R ROOM RP PASS I c��i�v�i�-� m aeia Ar wi�� ris� , Closed Tight LeN<cd ��- Checic V:�Ive N2 Held At 1Vhat P[Sll �. Closc� Tight Lealeed Clicele Vnke Nl FIeIA At Nhat 1'ISD CIVSed Tighf r,n llC � Z Date Time RP Date T11Tle � Passed or Failed Tagged Aate Time Notes : YVB Date Time PVB Leakc� Checle Vah�e Vlt Hcld A I�VLat PISD �� ClOsedTighf . Lcnlic�l ��. ci��i� ��;�me tn aem ��t wi�� rrsn CloscJ'1'ight � T.enlccd CI�ecIiHqlyeq2lle1Ae1l1ylialPlSU � Closcd Tigl�l � Le:�lte[I . Pretisure Diffe�'enfinl Relief VnWc O�enCU Af \Vhaf 1'ISD : Ditl NO'i' Open . C6ecl<ValrefllflolUAtl{'hxtPSlp • Closed Tigl�l - Lenked CI�ecleVnlvcq2HeldAt}VhatPSN ��, Closed Tisht � Lcalcecl press�rcc lliifrreoll�l Relir.i Valve Opened At R'hflt PS7D �; DiiI1VOT Open F�.�� I'�S 06/OS/2019 3:50 PM RFLIEF VALVE OPENED BEJ,OW 2.0 evs �'��, OPened AI}Vii¢tl'Slll '.DitiN070pcn . .. ��. . ...... . . . ��'. Did OPEN '��. Cheelc Valve He�d At }Vha1 PSID j rw 3 ar RP SS Yes No Yes No I.S Opened Al �l'�nt PS1D Dltl NOT Ope¢ . Date Titne AllZ GAP ONI,Y Final Test Results Date I'imc Testers H'ull Name: lllte Tiuie Did OI'CN CLeNc Valve Hcld Af �\�int PSID -� m�ens�� e�i ��, r��i ��n�s nhovc ovcr/lon' rl�n a�� c�„ MARCl BUSICK 0£/O6/2019 10:20 AM Snppl)� si�i.e Oinmetcr