HomeMy WebLinkAboutBackflow Test1
Dean Owens
From: Kathleen Clark <kathleenlclark@gmail.com>
Sent: Thursday, March 18, 2021 4:25 PM
To: Dean Owens
Subject: Fwd: We have received your response for City of Carmel Backflow Test Form
Proof of testing, proof it passed.
---------- Forwarded message ---------
From: Carmel Backflow <Backflow@carmel.in.gov>
Date: Thu, Mar 18, 2021, 2:31 PM
Subject: We have received your response for City of Carmel Backflow Test Form
To: <kathleenlclark@gmail.com>
Testers Email collinsj@allfire-solutions.com
Testing Company's
Email
mccollumj@allfire-solutions.com
Customers Email
Select Tester From List COLLINS, JASON_BF18-6318
If Tester is not on the
drop down list please
add their information
below
Larry Dunham
Gauge Information 920694
2
Phone Number (317) 883-9433
Calibration Date 06-24-2020
Select Company or Self Company
Company Name Testing
For
All Fire Solutions
Phone Number (317) 883-9433
Address Street Address: 110 south park blvd
City: Greenwood
State / Province: Indiana
Postal / Zip Code: 46143
Select Service Use Commercial
MANAGER NAME or
COMMERCIAL
CUSTOMER NAME
Kathleen Clark / Hyperbaric Oxygen Clinic
Type a question 60897451
DEVICE LOCATION
ADDRESS
Street name: Hazel Dell Parkway
House number: 14555
City: Carmel
State: IN
Postal code: 46033
Country: United States
Existing, New or
Replacing Device
New
Reason For Replacing,
Removing And/or Other
Additional Information
Added new fire protection system in the
Hyperbaric Oxygen tenant space.
Device Serial Number 52279
Manufacturer of device Ames
Device Size 2
Model Number Of
Device
2000B
Type of protection Containment
Type Of Service Fire
Type a question South side of building in Riser Room
Hazard Code DC
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
3
Date
Time
DC DC
Check Valve #1 Held At What PISD 2.6
Closed Tight yes
Leaked
Check Valve #2 Held At What PISD 1.8
Closed Tight yes
Leaked
Date 03/11/2021 11:30 AM
Time
Device Pass or Fail PASS
Device Tagged Yes
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
Closed Tight
Leaked
Check Valve #2 Held At What PSID
Closed Tight
Leaked
Pressure Differential Relief Valve Opened At What PSID
Did NOT Open
Date
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
4
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: COLLINS, JASON_BF18-6318
Date 03/18/2021 2:20 PM
Time