HomeMy WebLinkAboutBack Flow Results - Club Pilates Carmel
Testers Email michael@justindorseyplumbing.com
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Michael Rodgers
Indiana State
Certification Number bf19_06672
Gauge Information 10190876
Phone Number (317) 745-4830
Calibration Date 01-30-2020
Select Company or
Self Self
Select Service Use Commercial
Type a question 1564886044
DEVICE LOCATION
ADDRESS
Street name: Weston Pointe Drive
City: Zionsville
State: IN
Postal code: 46032
Country: United States
Existing, New or
Replacing Device New
Device Serial Number 4784549
Manufacturer of
device Wilkins
Device Size 2
Model Number Of
Device 975XL2
Type of protection Containment
Type Of Service Domestic
Type a question back of the building
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 9
Closed Tight X
Leaked
Check Valve #2 Held At What PSID
Closed Tight X
Leaked
Pressure Differential Relief Valve Opened At What PSID 3.4
Did NOT Open
Passed or Failed PASS
Tagged YES
Date 06/10/2020 3:00 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 Results Measured vertical inches
above overflow rim Supply size diameter
Air Gap
Date
Time
Testers Full Name: Michael Rodgers
Date 06/11/2020 10:40 AM
Time