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Home My WebLink AboutPermit Backflow Test 1997-10-16 " I,. ~ ~ - @ ~ WILDISH BUILDING P.O. BOX 7428 EUGENE, OR 97401 541-485-1700 541-683-7767 Fax ~ ~ CO. ~~~TRj @~ [j'rnill~@~~[j'[j'ill~ DATE 10' 1L?7' q7 I JOB. NO. 5206 ATTENTION 'f2A.-~ ~ RE' LTD THURSTON STATION SPRINGFIELD, OR TO ~J61fi~V~~UJr , . ~/a32'-' "t-'ZJ7 ~ ~ ~tJ6rf1t0.-PloP-. q7~77 WE ARE SENDING YOU o Attached o o o Shop drawings o Copy of letter Pri nts Change orderD leoPIEs DATE I NO. ~ ./, ott<GtIN' ,i.,,\ ~A ~ -+ l U?P1 ) I . 1 V' ~rr-U q7?71f9 5"t7J .~ 61...... _,t- o Under separate cover via D Plans 0 Samples the following items: o Specifications DESCRIPTION J; ~TATUS "'~ ~~~~{~ -t!- /7 tbl 7~ J:a2-- W1~v Ul17W- ~ ~(cr I I I THESE ARE TRANSMITTED as checked below: o For approval ~or' your use o As requested o For review and comment o FOR BIDS DUE 19 o PRINTS RETURNED AFTER LOAN TO US REMARKS PLEASE DO THE FOLLOWING: STATUS: o Verify all dimensions o Select color desired [] Select numbering desired o Return approved copies o Prepare shop drawings and Submit copies A-Approved as submitted B-Approved as noted C-.N,ot approved revise & resubmit ~ 'e,.~rJ}}~T .A-:1.":7tVl ~ ~ COpy TO MIJ L rO [ WI ? . M$l ~~e~~~s~k;ndIV no'~~~~a~~~ce.(f;;::, PROJ.MANAGER American Wlter W~~~tion PACIFIC NOR,nw.SECTION 176515 ~ [JNEW DEXlSTING DREPLACEMENT PROPERTY OWNER, MAILING ADDRESS, CITY ASSEMBLY r r n.. ,-;, //,/." / / I ~5- ADDRESS, '- ~v- 7 / .-t' - '<:-,}I _ STREET' O-R.P.B,A 0 D.C.VA ,< 0 P.V.B.A. I" 7.<::0 AIR GAP SIZE L$J'.LlJ MAKE, {,J//A:://J,--, _ MODEL, //.=X "'- 'f6'lJ[YOR, ,-5i /-:? ~~~'ilER0Y_3'3~Y' t&~~P6~ rJ V I /A) ESj' c;/ ~/I;:-';- /;:) -3 /...})d/ /; {if (~.4 / /' // A/piC :7/ /~ 11./.) j /7/,/ J.Jt;/Jdj.:y;; / REDUCED PRESSURE ASSEMBLY. [PRESSURE V ACUUM I INITIAL T~':;; " CHECK a DOUBLE CHECK I BREAKER PASSED E)- PRESS DROP (i/ (A, CHECK II lAIR INUIT CHECK I FAILED 0- INITIAL ~V::-VE y, ~ (11) TIGHT 0 OPENED AT' PRESS DROP ~~E/' 1'2L G7 TEST MlN2PSID 0 /u /~ / . RESULTS BUFFER 11 ') LEAKED PSID PSIO CONFIRMATION . A - B = - . ~ CHECK 12 TEST 0 /MLN J PSI TIGHT 0 DlD Ncrr FAILED SYSTEM O OPEN 0 0 PSI o LEAKED BACKFLOW ASSEMBLY TEST REPORT / T 0 jrirk uui "cCT PHONE, .. / STATE _ '""II ZIP RELIEF VALVE PASS 0 FAIL 7t, /(' rJ C-:/~/ r? c/ ('/'l'e R .I.];..-5"c , COMMENTS REP^",S ANDIOR PARTS TEST AFTER REPAIRS REDUCED PRESSURE ASSEMBLY ,1CHEC'K \./ ~y I pcv,,- PRess DROP J,u (AI, .... "." . REl.lEF c- // I CHECK II OPENED AT PRESS DROP OPENED ,::h / ,"I TIGHT 0 .....'....0 BUFFER 0, q I CHECK 111. A.a.. ..I..).... TIGHT 0 I"SW P'SID IN COMPLETING AND SUBMrrrL~G THIS TEST REPORT. THE TESTEK CERTifIES THAT THE ASSEMBLY HAS BEEN TESTED AND MAJNT AlNED IN ACCORDANCE WITH All APPUCAB~ RULES AND REGl1U.TIONS OF TKE WATER SYSTEM, AND STATE REGULATIONS. I" P.V.B.A. AFTER REPAIRS DATE, /0 tAl 1-// { DETECTOR METER READING /<~-/'l~,2 0 ;&;2 TISTER SIGNATIJRE v?, ~ -.J / - --- ~ / "''' ), / / '--- <; r /.7/ TESTERS NAME PRINTED /-1 //) /~...C GAUGEI' TESTERSADDRE5.> I / I.u.\. CCMPANY NAME \ . ~;:., \. ~. 4. . \.. \~. REPORT RECEIVED BY, l(REPRESENTATIVE OF gWNER) . PHONE,",: II SERVICE RESTORED WHITE. Water S)"tem Copy PINK. Cwtomer Copy YElLOW. Tester Copy . ,. f>..";:" .!.:/..... : rff::.. . :#: ,', ~~" ,', ..x;' I;;':,'; ,.'.... . ,..,,- ", /".,','. .11r1' . :0.'/ -~' (.W?:'. :" jf' ~,<,/ 'it' ~", ~. : f. ~ . ""~: 1L.'-' *t ~:. 1,/ fJ.' 'T/ J.; ~: &, ~~{.. 'I\~"(': " ).." \i;, ;'/<, ~- . >~" " /;. 1:/. .~t. ~, . i ~" i ~;:~ <',; ;~/ /0. J: ~: ,{? ;f., *1 :;.;- f ',' ;";A~;i?7~1{~'3?'1~"'Ir'~;'; "i~,. _)~t~\"\?:y{~:!"?,,W.~ ..:;:-:' . tc,":<;;::;, i~ \:~:,^ ,1.'~,: ":. ";"'~:''.\1i:~;', "':' . ,\:;~~::j*:~~tE~t~~~~~~~ci~~~":'Ji:':'~,: :i16'51~5:;~; .- ;'~::,~:~~~;.;)~~~i,"';,' ..,:....~:,: .:';:,~~!:,:~;',/~.:::':':;:;,:".i~~',. ;;;{ ~" " ." , . ," '" ' '." " I:lEXISTINO..." r" ';"::'..),t~<;:~EI,.9WASSEM~L V;r.ssr. REPOR.1\ g~P~AC~~Ni~), "PROPERTY ::,;f:.r.-,,:R';i;};:' . ",/,' ,. ,'i.', ',;/ ,:",."" , '. .;,.', ..... '" . :; OWNER, '" ^";:I.;i~Y.~;Cl?'f;-K;'A/ 1', ,::1~;.:i>HONE:'" ":-,~"'~::.:~;:;"l:J: p~~b~~~f;;:;r,~'~t~,;;f '. <, .' . :,>;':. ~A~ -;::~: ",: ~l;:~<': c,:. . ';: <..: ;.~~~~~r"'~~~~Z~~~p~.'~,~.~,~,f1" i~," ':;.:~f:,:~': ~,." r. ~,yr,A, ..., """-~,', .,DOJ:^",;o""",.."l;J~,l\:J';;"J!;.~II'JRO{J")';;:-" ' -'....'SlZE ',.'<' . .uj;',.MAKEi:..v." '~'II K/'l;.~'::~..'II'~0[i.E'iJ1;Phjx.:<,'L';':~T~;~L:...:e-,.., I~";' ~'WAnR',"""c,;.:"";;A,m,,; ;;. "", ;..",.,,'-'1',...:.... ';,.~SER,iA1:~~:l,(l9"f:'''''>"l'''.,..;. ,'/.' A.:....,.,s,,'..~,"'.,.:.,', '. '.PURVEYOR.:',,!.:\"')e:.,,;<'::si?t ," """~""''':'i':'U~'BEll;~~-~~4'',:''''!Il':':' \::ASSEMB~.Y:"""ij),dfS'" ~:B(~/, .-"'" ~~.>:n?' ""'?,""~ '.. '. '" '~,."'-S':.!..<,(,"";':',")"""." ,,~';';~t.'.' ;'1 LOCATION: ' ? ....JAJ;~/', ~,.;~';t~ l"-'r ..,.;,//" .."",", .,f......x; ,~~"S4Zvc.;,Z. ~~,'~.x:i~.., t: "..' ",:' ';..'4;!:;;j:;I;~' , ;7"~Ypl~~~#;&f~i.y);hkt!y(;)jll74?-~ !i," ./', REDUCEit~' ~UREASSEMSi5Y:,,:;;,~'i<<.' ~,V...tU.UM 'INrrlAi~'-T.,~ :.' . '" .~, ~~ ~'" . r. il'CHECK' '"r ," ~~ ,,::' I DOU8LE~CHECK~ BREAKER ~", .'PASS~: J;;$f'::";'-;. i "', ~~,~~O":-, _"~'.(A)" 'CHECK-,'I'Jh:l'jAIR'INLET CHECK.- ':'fAruED'd~;:- ; INITIAL RE1JEFVALVEf' --a.4.c ";::-:,, ,.,',::"'.,,~ ~~ DATE:', 0<., ., .; O""EDAT' . .'1 ~~(8) nGHT,:',*~""~~:~O""EI,>A:' 'Rf.'S'O~O' /~/' '/:21'!C:7 ~r TEST 'I,. ", Plot .J>SIO'1;... LEAKED""';" C ".(0. .., . ~. t:t..:;I"'_/~_h-7~(.. ;RESU,LTS S""-.2U 'ER'. - "",~'-I-~, .. ,; ,.. .' ., CONFIRMATION""" '. lUFF \; . _, "~('" .;~..PSlD PSlD .... + '. ..... ~::, , . . .'. A ~,8'=".,. ~ l. .1" '. CHECK'2~ '~..".':' ," r..~ TEST.~ ..... -0""' ~ ~.~ ." ,..-....,MlNJ:P'Slt~j;.."., . _ .. .,,~\. ..-......r.\.. _ .' . . ,"'. ,',' .'. ;:.~ '-:;. .1: ' .'..;,' '~;'j;:"" TIGIiT~ . .0" '.:', DID NOT, FAILED:' 'SYSTEM A',w'< ',.". ~LIE"VAL~E"~~'j'" , ., ,.,. -"..,,: '~:--P,;'N'O ".'0' '. PSI'": ;.:"'{;. . '.",' P."" ''''','' --. 'n",,' 1;' .~... - LEAKED'"-'-'''''"''''' ""'~~'" ."'~, "...,..,. 'oo .L." '- " . PASS,,", ,AI'.},'''''''' ..' ,.-c~"-:"__, ~:"'~:",,, ..',.'" .Ii,...,........'..,. ",. ~:co","Elff7 .?r:4:::~~;~):::' ;.f,?~ ~~,j?'~'!-;Jif~;ji#(''j.?;.f'~:. .::'" ...' . IlEPAOU l~ 't ~~. f../l1iJ:;.:' .}. .:~~. ~! '''~'>''r '."-' " ~, I .~ ,.' I. .I't.... ;1 . , "'" . (~~~.:~:~C;:!>:.;':t:!g~r:~.. : '. "3~;:."::~':';~t.:,;:> :~,.I- . .,{ .,...Z,-<;. ", , ~ .... ..,.., ,- I ..~ ~. ">;"r<'l;,.",: . ',' " , ~.. .t~'." .,.~ . '-',REi>vcEi>~~'''''EM.LY . . ''''..''I...,''.'P\1S". .', '..;' ."",C'";,;C" 'I:CKECK'"~ {-j;,'rO:"'K~ ....,- ... D.C.V.A.,{\> .-.; <.:J.~,"':~''''''::.' :~.... ~ AFT~R:,R$_PA{RS.. ."1:. ,PRESS,~ROP ,"",'j"'e{AI .... -. '~'-,j, II ~ :,. ,.'" '\. '~"""!1~u'" .ELIEF..'", !.'i c<Y)'..:j!S' ilCH,ECKII ,;,;f,C" O""ED,A'" 'OW"D'.O,.' 'BA,T.',E:!,;",,":,;!,,~:'.,\>.,~.,:. ~::!': "'13.,:;~:~IICH~G::~:'.. . :~~'?'" .j,:" .', /a~p<J'I!9?,:.;...'.' A 1-' ,~i~., - D~' - ',' .. . , . I. 1IIl,.,.",,'r ' '.. TIGHT . '',-'~I?W .., ..~. n:w t~~'.-'~~. ... '.,', t :IN COMPLETINq~DiSUBMrrnN.O T1GSTESI'JlEPt)IT;~tHE~.CERT~,n.ATlnm,:_;".-..~. ,:t::' --,,' '. ..-\SSDIBLY HASBEf;P1 TESTED AND NAlNTAlNED IN ACCORDANCEwrrH ALL'APPUCABLE,," "''';':';'.1. -:.. '''';,\ ; iJ~~~~~~~'f~~iiJ:~;'~,' ',. _ _.___4.4 ~'~, - -, '_ _, ;( .TE5TIRSlqNAruRE,~. jf.f{!::.s-.:?"-; 2'Z-'?'.:"~'-;'\ :'.:" ," :"7;~&;("1, >,(.',. r ~NAM"~ ':::,;r,{:~/.,,: ..:-;.t::~.>:'L~.t~:,:-;,':"-";:,'~'~~:iN,.~:.~~:.:.'~:,;r : TISTIRSADDRESS. '-: ," "b"~"..\ ~ ).,''- . '''.' '.: "HONE....'. 'C.- , . G '..C.,,7:{;-~~ . I' ...;',:('). -'.',)' ':"":"':..'F'..*,,,: :',tl '; CO",'ANYNAME .:\:r~' ~;<*'\" 'Q :,' ry" .;' :..,;.r. '..t. '. -, ~ ,;".' . ~"i~:j"~;:h':,' ".,',. ~'. ~ ..~t\r".j". ",' . ...~..,./'", ~.."..j'rl. ..., ,.,..~ .: .,.' F' ' .. .:.' - . _ .~.': ,0 0 SERYlCERESTORED;' . .;.' REPORT RECEIVED BYt _ .... (REPRESENTATIVE: OF fdWNER)' I ~-r . ~..~;,.. ~ '.; .; '.' ',: 'f..~~..J~.. }"!I', a':" :.~. " .., ,J ',.1 ~;-:...~. : ,'- ~ f."l..;1'I'~.;-.::mt~....., .. -;'f~':''''''~~~:l~'';''''''- ;' ..' ' , . ',1 ~r '..,"11-':;;--, "~. .,. .;..'\.';.l,.-Itt":-"J : ,...t'''''.t.:-.c.... .~~:- .. ';" ~ ,. _'j..~. ,," '. '.I'~. .....'1 ~f.. I. ,I, (. ,". t, ..'~ ....., {,o;' ,..~wt1ITE:WltCr~yatCm~'".... " ~K.CWto~j~:~..<'.,.;1~.~W.TtHtfCopy.~~~J"*- ~" :t'" ,. ~.'l::.;ll.\......,.,.~t".?ij.... .' >;7-.~~..rt;.-.-...;\;'S',...~^';:;!..,.,.j/>.~1:.~t',_.J1'if."...~~ .' .............'~--. ....c__'. --... .,...... .:~. ..-1.,__",,,,,,,, "',,;.y.~r.::l; , "-'.' ~,::::." .r;.'--,'.. :,:;;.~>:~: C:;j""'t, I"' ;;:- ",' ,," i, .' 1"- .... ;,.TEST '.AFTER {,REPAIRS ','--':,*,',';:, -- " .\,"'.' -- .'............. ..' ...~.~ ...... .~...~...-'... ~...~~.._... . P...~..... . 'U"",_'" .......-" ....;..: