HomeMy WebLinkAbout2021.03.31 Weston Pointe 895 backflow reportFrom: Carmel Backflow
To: Joshua Line
Subject: We have received your response for City of Carmel Backflow Test Form
Date: Wednesday, March 31, 2021 8:28:36 AM
Testers Email h2obackflow@yahoo.com
Customers Email
Select Tester From List MILLER, MARK _BF00-1725
Gauge Information 05122609
Phone Number (317) 626-9441
Calibration Date 12-08-2020
Select Company or Self Self
Select Service Use Commercial
MANAGER NAME or
COMMERCIAL
CUSTOMER NAME
Sandor development
Type a question 156488604
DEVICE LOCATION
ADDRESS
Street name: North Michigan Road
House number: 10985
City: Zionsville
State: IN
Postal code: 46077
Country: United States
Existing, New or
Replacing Device Existing
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 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 9.6
Closed Tight Yes
Leaked
Check Valve #2 Held At What PSID
Closed Tight Yes
Leaked
Pressure Differential Relief Valve Opened At What PSID 3.2
Did NOT Open
Passed or Failed PASS
Tagged YES
Date 03/31/2021 8:00 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: MILLER, MARK _BF00-1725
Date 03/31/2021 8:20 AM
Time