HomeMy WebLinkAboutCity of Carmel Backflow Test Form 4From:Carmel Backflow
To:Gregory Shadday/USA
Subject:We have received your response for City of Carmel Backflow Test Form
Date:Thursday, June 18, 2020 11:44:02 AM
Testers Email brian.sauer@grunau.us
Testing Company's Email brian.sauer@grunau.us
Customers Email
Select Tester From List HUGHES, TONY_BF11-4199
Gauge Information 4152474
Phone Number (317) 872-7360
Calibration Date 04-16-2019
Select Company or Self Company
Company Name Testing
For Grunau
Phone Number (317) 872-7360
Address Street Address: 6011 East Hanna Avenue
Street Address Line 2: Suite A
City: Indianapolis
State / Province: IN
Postal / Zip Code: 46203
Select Service Use Commercial
MANAGER NAME or
COMMERCIAL
CUSTOMER NAME
Cushman & Wakefield
Type a question Unknown
DEVICE LOCATION
ADDRESS
Street name: North Meridian Street
House number: 12900
City: Carmel
State: IN
Postal code: 46032
Country: United States
Existing, New or
Replacing Device Existing
Device Serial Number 29784
Manufacturer of device Watts
Device Size 1 1/2
Model Number Of Device 009M2QT
Type of protection Containment
Type Of Service Domestic
Type a question Riser Room
Hazard Code RP
Passed or Failed PASS
DC DC
Check Valve #1 Held At What PISD
Closed Tight
Leaked
Check Valve #2 Held At What PISD
Closed Tight
Leaked
Date
Time
DC DC
Check Valve #1 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
RP RP
Check Valve #1 Held At What PSID 5.2
Closed Tight Y
Leaked N
Check Valve #2 Held At What PSID Y
Closed Tight Y
Leaked N
Pressure Differential Relief Valve Opened At What PSID 2.0
Did NOT Open N
Passed or Failed PASS
Tagged YES
Date 08/05/2019 9:40 AM
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 Results Measured vertical inches
above overflow rim Supply size diameter
Air Gap
Date
Time
Testers Full Name:HUGHES, TONY_BF11-4199
Date 06/18/2020 10:40 AM
Time