HomeMy WebLinkAboutBackflow Test Results - grunau.us_20200928� \ `y��
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601 I E HANNA AVENUE, SULTE A
WDIANAPOLIS, IN 46203
PHONF. (317) 873-7360
Property Name: sn Mo�o� erod
Addt'Z55:571 Manon Blvd
City: Carmel
COIli2CI: Susanne Inqeqno
Customer focused. Built on values.
Annual Backflow Report
Work Order.
Inspec[ion Da[c: 10-21-19
L�s ection Location
Site #:
StdtE: W ZI :46�32
Phone #:
Date:io-zi-is
Assembl
DaCe oPtest 10-21-19 Time Supply Pressure Air Ga (2XSu I Diameter)
�� ��a ❑ M 55 LBS Su I IN Ga IN Pass F❑a'il
Type of Assembly Manufachirer Wilkins Model g75XL2
❑DC ❑✓ RP
❑DCDA ❑RPDA Size 2" Serial Number 4469307
❑PVB ❑SVB
Height off Floor Protection From Freezing ✓ Yes o Flooding ❑✓ Yes�No New Yes ❑✓ No
Installa[ion
3 Ft In
Only if Applicable-Include Previous Serial #
Orientation Service Protection
❑Replacement Assembly Inlet Outlet ❑✓ Domestic QContainment
❑New Installation ❑ 1' Ver[ical Up T❑ ❑Fire Line ❑Isolation
❑Stolen ❑ � Vertical Down .� ❑ ❑Irrigation ❑✓ Containmentbylsolation
Previous Assembly Serial ❑✓ --� Horizontal �Q
Location/ Comments R i se r Roo m
, G GRUNAU
Customer focused. Built on values.
601 I E HANNA AVENUE, SUITE A
INDIANAPOLIS, IN 46203
PHONE (317) 872-7360
FAX (317) 873-2133
www.grun�u.co�n
Annual Backflow Report
Work
[nspection Date:10-21-19
An No Answers, Test Failnres, Or Other Problems Must Be Ex lained Here
Sianatures
Test Gau e Maker M�awesi Test Gau e Model e�s Last Calibration Date
Tested By: (Print) i � e Repaired By: (Print) (Signature)
Matt Brown
Company ��.� � a� Final Test By: (Print) (Signature)
Certification # BF08-3502 Expiration Date Owner or Owner's Representative Dafe
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i
Customer focused. Built on values.
601I H HANNA AVENUE, SUITP A
INDIANAPOLIS, W 46203
PHONE (317) 872-73G0
www
Property Name: s�i Mo�o� ei�d
Address:5�i Monon ei�d
Clty: Carmel
CORYdGt: Susenne Ingegno
Email: Susanne.lnqeqno@cushwake
Annual Backflow Report
Work
Inspactian Da[e: �0-21-19
�ction Location
Site #:
IN Z,i :46032
Ph011� #:
na(P,[10-21-19
Assembl
Date of test 10-21-19 Time Supply Pressure Air Ga (2XSu 1 Diameter)
n � oo � f��V( �
PM 55 LBS Su I IN Ga IN Pass Fail
Type of Assembly Manufacturer �n/ilkins Model 350A
❑� DC ❑RP
❑DCDA ❑RPDA Size6" Seriaf Number U51435
❑PVB ❑SVB
Height off Floor Protection From Freezing .'❑YesONo Flooding ✓ Yes❑No New ❑Yes � No
Installa[ion
3 Ft In
Only if Applicable-Include Previous Serial #
Orientation Service Protec[ion
❑Replacement Assembly Inlet Outtet QDomestic ❑� Co�tainment
❑New Installation �✓ T Vertical Up T❑J �✓ Fire Line ❑Isolation
❑Stolen ❑�. Vertical Down �. � �Iirigation ❑Containment by Isolation
Previous Assembly Serial ❑-� Horizontal ��
Location/ Comments � i s e r R o o m
� G �RUNau
Customer focused. Built on values.
6011 E HANNA AVGNUE, SUITE A
INDIANAPOLIS, ]N 46203
PHONE (317) 872-7360
FAX (317) 872-2133
www.grunau.com
Annual Backflow Report
Work
Inspection Date: 10-21-19
An No Answers, Test Failures, Or Other Problems Must Be Ex lained Here