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Home My WebLink About20240913SWS to Staff 91 Supplemental Response - Test report 1.pdf RECEIVED Friday, September 13, 2024 IDAHO PUBLIC Water ' lFHe UTILITIES COMMISSION Purveyor: 1 I U n e Q ( V t No: Service Address of assembly i I r7 Location of assembly on premise r' Supply to: n n K I a Owner of assembly: p. Owner address: V e r KS `'i I I�Z City I� jj1 ZIP Manufacturer: Z,-L-, ,' Model No: - I-L7 size_�_Serial X7�y 277 Style: RP O DC DCDA 0 RPDA O PVB O SVB O Orientation New Svstem Pressure Instal! ? Reduced Pressure Principle Assembly at this location Y LNS> PSI Double Check Valve Assembly 7-1 -r Check Valve# I Chec�Vaiyy# Relief 1'ulve PVB/SVB INITIAL lleld at �. ( PSiD Held at �, ( PSID .4ir inlet TEST Opened at PSID opened at Closed light )U- Closed tight Did not open 0 Opened Full_v O Leaked 0 Leaked 0 Did not open O Check valve (:leaned O Cleaned 0 Cleaned 0 held at REPAIRS Replaced O Replaced 0 Replaced O Leaked 0 Cleaned 0 Replaced 0 FINAL Closed tight Closed tight Opened at Air inlet TEST Leaked O Leaked O Did not open O Check 6 alve Comments: initial test bv: Chris Nash Date: b J3 Certification/License# B AT 2S341h Pass10 Fail 47 Repaired/Cleaned by Date: Final Test by: Date: Certification/License# Pass O Fail 0 Water senice restored? N BAT Form—pk LW 0 � bef k-sh„re-, BACKFLOW PREVENTION ASSEMBLY TEST REPORT CUSTOMER NAME R (4 6L Q z SERVICE ADDRESS f ]e-r 5 h LOCATION OF ASSEMBLY �C ' fyt 't/) SUPPLY T TYPE OF ASSEMBLY NEW INSTALL PSI C)4) MANUFACTURER �,.�I . ' �(� MODEL SERIAL /,+7 ! ,97 -7 SIZE f PVB/SVB CHECK VALVE#1 CHECK VALVE#2 RELIEF VALVE AIR INLET OPENED AT PSID � HELD AT = PSID HELD AT -A'I PSID OPENEDOPENED FULLY n INITIAL TEST CLOSEDTIGHT CLOSEDTIGHT T PSID DID NOT OPEN ❑ LEAKED c LEAKED DID NOT OPEN u CHECK VALVE HELD AT LEAKED u CLEAND a CLEAND ❑ CLEAND ❑ CLEAND n REPLACED u REPLACED REPLACED n REPLACED c REPAIR/FINAL HELD AT PSID HELD AT PSID CLOSED TIGHT a CLOSED TIGHT � OPENED AT PSID AIR INLET OPENED AT PSID LEAKED E7 LEAKED DID NOT OPEN ❑ CHECK VALVE HELD AT PASS FAIL NOTES GAUGE p 3 � ' l MAKE AND MO DEI },I y� L CALIBRATION DAl E I ? TESTER LICENSE DATE c REPAIRED BY DATE 77 / F11AI TEST RY C1 ! 0VJ,1 LICENSE � 4 - ��G > GDATEATER PURVEYOR a cc Ym Nash S� Son RPM Nash *I ANfI�_rIC A 208.SOO.9747 Call or Text for an Estimate BACKFLOW PREVENTION ASSEMBLY TEST REPORT CUSTOMER NAME -S f,4,✓ SERVICE ADDRESS LOCATION OF ASSEMBLY / SUPPLY TYPE OF ASSEMBLY f�/ NEW INSTALL A' PSI MANUFACTURER 1.�/L (�/^/� MODEL j'/L SERIAL 4SI7/_ 6 5 S12E / PVB/SVB CHECK VALVE#1 CHECK VALVE#2 RELIEF VALVE AIR INLET OPENED AT PSID INITIAL TEST HELD AT /D•/ PSID HELD AT /C,l PSID OPENED AT Z.Z PSID OPENED FULLY e CLOSED TIGHT CLOSED TIGHT DID NOT OPEN Li LEAKED [; LEAKED q DID NOT OPEN CHECK VALVE HELD AT LEAKED c CLEAND n CLEAND REPLACED o REPLACED U CLEAND CLEAND r: a REPAIR/FINAL HELD AT PSID HELD AT PSID REPLACED �: REPLACED CLOSED TIGHT ❑ CLOSED TIGHT u OPENED AT PSID AIR INLET OPENED AT PSID LEAKED n LEAKED n DID NOT OPEN o CHECK VALVE HELD AT QOASI FAIL NOTES GAUGE k 2�1 .(�.�� MAKE AND MODEL JvI //JLvr�r , -/S S CALIBRATION DATE (0%y TESTER `(- AI S /✓/-A S'// LICENSE &A L f g DATE /vf� 'I / •7 — 2 y REPAIRED BY DATE FINAL TEST BY LICENSE DATE. WATER PURVEYOR 5�i-O b6fe: L(r// / j /�_S Nash & Son RPM REALTOR'•LANDSCAPING• EXCAVATION 4 - 208.500.9 747 Call or Text for an Estimate li'ater ((�� yy�� -h - � File ey Purvor: �l�n L Q I d n� Uti I I 3 No: Service Address of assenrblt• HS hhD Y K s h l h Location ofassenrblti,on premis K oe Q ht at h u )-(- Supple to: I n tys Owner of assemb/1': U Q n Owner address: Cut, 51 on C h C&U ZIP UL14 tlanujacturer:�� . ,ltnrlel No: Z Size / Serial C oEg C_ Style: RP DC O DCDA O RPDA O PVB O SVB O Orientation New System Pressure In.ctallat Reduced Pressure Principle Assembly at this location }' �� Double Check Valve Assembly 7� PSI Check Valve# I Check Valve#2 Relief Valve PI B/SVB INITIAL Held at Z P.SID Held at YPSID Air inlet TEST Opened at ' -Z_PSID opened at Closed tight� Closed tight Did not open O Opened Fugv O Leaked O Leaked O Did not open O Check valve Cleaned O Cleaned O Cleaned O held at REPAIRS Replaced O Replaced O Replaced O Leaked O Cleaned O Replaced O FINAL Closed tight Closed tight Opened at Air inlet TEST Leaked O Leaked O Did not open O Check 1 alve Comments: Initial test by: C h r i s N aM Date: U 2.3 Certification/License# V AT 2 Pass 47 Fail a RepairetUCleaned by Date: Final Test by: Date: Certification/License# Pass Fail O Water service restored Y N B 41 form sample U% I y 5r1 131a nc h,a r CL Near ExI Stu na BACKFLOW ASSEMBLY TEST REPORT a Removed QReplacement Property Cass+e I\Iale owner Ma111110 1459 Blanchard Elk Rd Blanchard, ID 83804 Address Phone Assembly 1459 Blanchard Elk Rd Blanchard, ID 83804 Address QF4Pa A ®QC VA a R PPA [:3DCDA a Pv nA � svr. gaAy! QA)"r.AP SIZE 1" MAKE Febco MODEL 850 water Purveyor Stoneridge Prop. Water Msttwt se►tal • HB93989 Assembly Location Behind water feature vw0trCleo Pitt la ' MtTtAL TEST �geS800ftor ckato "� +T - PASSED 0 CA IN IT tAl .� TE5? ! •r VALVt etrto PMP? FAILEDRESULTS ~:`'fr AT f.AKED A7 t DA'E Ah�i V$iC7lfEllo" PStal 0526-.23 A.a - CA'acxBYPASS '' 40tcArstt► SYSTEM PSt CHECK "fli-Wf VALVE AZK 0 r A. KuccCl0 O aS COMMENTS Replaced both #1 and #2 checks retested REPAIRS AND/OR PARTS EDUCxv PRE 41 + a V.f1 A E A TEST *I s1 C>ILc+c rK., 2.2- REPAIRS AFTER Pfessrv- .. ►ioHt rt.10 �wtW;; VW.!L% RE.PAW-M RI`er ® O opI:hto —le. 0 -�23-23 �veto c�c.►e .t 2.2 �sz�_ �,�u A a ' PASSED W CCrM l'V VSNG AM xoe1ul?*t G TMJt TVST IWPDXT.rME M&TEfi 42*01Ti08 THAT THE AasC"KV HAS IMEN TV4-ED A► n MAlKtAJW&rN ACa'.0ftU A0Cr Will ALL Ak-PUCAaLr ►ttJt.E• AND ftCOLlAt► *4 CW Tb-f W AIFfl SYS MA AM STATE"►tEGUAT10446 GAUGE CALIBRATION DA!L 02-28-2023 DE-TECI ORME-fEk READING 'l J mes Williams 12087777688 sate Twet, Darnall Sprinklers CwtifferdtA . s Bat-16583 3172 W Setice Way Post Falls, ID 83854 Gauge 0 12091184 [3 tiERVICE RF_StORED CI FOUND OFF. LEFT OFF 19 59 u 1a-nchu F7 New MExisting BACKFLOW ASSEMBLY TEST REPORT = Removed Replacement Property Cassie Nale Owner Mailing 1459 Blanchard Elk Rd Blanchard, ID 83804 Address Phone Assembly 1459 Blanchard Elk Rd Blanchard, ID 83804 Address a R P B A. ® C V A [D R P D A [=] D C D A a P.V B A [=] S V B A[=].A V B. O AIR GAP SIZE 1 " MAKE Febco MODEL: 850 Water Purveyor Stoneridge Prop. Water District Serial # HB93989 Assembly Location: Behind water feature REDUCED PRESSURE ASSEMBLY DOUR_E CHECK : V 9 A 5 v I?A INITIAL TEST 91 CHECK AIR INLET CHECK INITIAL PRESS DROP (A) CHECK #1 PASSED TEST RELIEF VALVE TIGHT ® 1 .3 OPENED PRESS FAILED RESULTS OPENED AT MIN 2PSID (B) LEAKED 13 PS-D AT DROP DATE SUFFER CHECK M2 PSDI PSDI 05 D8-A-B - 2-4 BYPASS MIN 3 PSI CHECK RELIEF VALVE TIGHT ® 2.2 DID NOT FAILED SYSTEM PSI DPEN PASS [3 FAIL O LEAKED PS'L a 1 13 COMMENTS REPAIRS AND/OR PARTS ,=DUCED PRESSURE ASSEMBLY D.0 V A P V B A S V B A AFTER TEST et CHECK CHECK 01 REPAIRS AFTER PRESS DROP (A) TIGHT PSID OPENED PRESS REPAIRS RELIEF Q AT -R:-P DATE OPENED (B) MIN 2PSID CHECK 42 PSDI =5D1 BUFFER TIGHT PSID A-B Q PASSED MIN 3 PSI IN COMPLETING AND SUBMITTING THIS TEST REPORT,THE TESTER CERTjF ES THAT THE ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE RULES AND REGULATIONS OF THE WATER SYSTEM,AND STATE REGULATIONS GAUGE CALIBRAATI N DATF 02-05-2024 DETECTOR METER READING Taylor Fulwiler 12087777688 State Testers Darnall Sprinklers Certification #BAT-23282 3172 W Setice Way Post Falls, ID 83854 Gauge # 02120756 REPORT RECEIVED BY ❑ SERVICE RESTORED ❑ FOUND OFF, LEFT OFF �0 Water, - n e Q d a U-h I I fi ( s File Purve►'or: ,1'0: Service Address of assembly I �r o U K W Q�q Cfi Location of assentbli•on premise l crf of 00 1/1 t Supp&to: n Y 1 1 K I t V Owner of as:semb&: Vim a n d V a w c L Y N L r— Oµvter address: I2 YD /O KW a �-Cho, (,�{� Ch((Y ZIP cul Manufacturer: 1.,�, f L< , , ,tilodel No: /50 JC(. - Size � Serial3Z Style: RP O DC� DCDA O RPDA O PI'B O SIB O Orientation New Sti�stent Pressure Installs �! Reduced Pressure Principle Assentbll at this location Y Double Check Valve Assembly PSI Check 1'alve# I Check I'alve#2 Relief Valve PVB/SVB at Z—PS/D Held at 2• PSlD Air inlet INITIAL Held TEST Opened at PS/D opened at Closed tight Closed tight & Did not open O Opened Fullj, O Leaked O Leaked O Did not open O Check valve Cleaned O Cleaned O Cleaned O held at REPAIRS Replaced O Replaced O Replaced O Leaked O Cleaned a Replaced O FINAL Closed tight Closed tight Opened at Air inlet TEST Leaked O Leaked a Did not o en a Check Valve Cuntntents: Initial test by: l.r I Y S N Q Date: Certification/License# 4w Pass Fail L7 Repairecl/Cleaned by Date: Final Test by: Date: Certification/Lic•ense# Pass O Fail O Water service restored. Y N BA I Form maple I N BACKFLOW PREVENTION ASSEMBLY TEST REPORT CUSTOMER NAME SERVICE ADDRESS (� v �, ' 1 -(� �} j (� LOCATION OF ASSEMBLY e I L)�A sic SUPPLY TYPE OF ASSEMBLY NEW INSTALL PSI MANUFACTURER ` 1 h n MODEL SERIAL y '7 [.)( SIZE ' PVB/SVB CHECK VALE#1 CHECK VALVE«Z RELIEF VALVE AIR INLET OPENED AT PSID HELD AT �PSID HELD AT y UPENEDAT PSID_ • ) PSID OPENED FULLY ❑ INITIAL TEST CLOSEDTIGHT a CLOSED TIGHT sl DID NOT OPEN ❑ LEAKED p LEAKED DID NOT OPEN CHECK VALVE HELD AT LEAKED o CLEAND n CLEAND .- CLEAND CLEAND n REPLACED REPLACED ❑ REPLACED REPLACED ❑ REPAIR/FINAL HELDAT PSID HELD AT PSID CLOSED TIGHT CLOSED TIGHT OPENED AT P511 AIR INLET OPENED AT PSID LEAKED r. LEAKED DID NOT OPEN a CHECK VALVE HELD AT PASS FAIL NOIIS GAUGER �; y,� ( I MAKE AND MODEL Y j _� CALIBRATION DATE y TESTER LICENSE DATE REPAIRED BY �. DATE ! / FINAL TEST BY �� ' (:) n LICENSE , 'r _ 3 DATE 1 Z � WATER PURVEYOR J,'k 4 Q Ojtr Nash & Son RPM ''-I AN I'llICf7 J 208.500.9747 Call or Text for an Estimate Water Pile Purveyor. aT w d Uti I I fiI_r S No: Service Address of assembly 1�r b Q K " ti q H Location of assembl►'on premise ho L)1'L Supply to: n d Owner of•assembly: (.ha r I o (o o V_ Owner address: � I �f �o Kw a y e."�- no, 1111 o`'1(Y'� Manufacturer: vn . � �i 1/ndel.1'u: �2 / L Size_ Serial �b[L!� _ Sole: RP D DC ZDCDA D RPDA D Pl'B D SVB D Orientation New System Pressure Installat' Reduced Pressure Principle Assentbl}� at this location Y � Double Check Valve Assentbll &�—-PSI Check Valve#1 Check !alE, #:2 ::r Relief Valve PVB I SVB INITIAL Held at PSID Held at �_' :Z PSID Air inlet TEST Opened at PSID opened at Closed tight � Chased tight � Did not open a Opened Full►, O Leaked D Leaked a Did not open a Check vah•e Cleaned O Cleaned O Cleaned O held at REP.-AIRS Replaced O Replaced O Replaced O Leaked O Cleaned O Replaced O FINAL Closed tight Closed tight Opened at Air inlet TEST Leaked O Leaked O Did not open O Check Valve Initial test by: (. 0 N� 1 Y Date: Certification/License# Pass Fail,O Repaired/Cleaned by Date: Final Test by: Date: Certiftcation/License# Pass D Fail O Water service restored? BAT Fm sample LW ✓ � I 13�ool�wa� BACKFLOW PREVENTION ASSEMBLY TEST REPORT CUSTOMER NAME 4 SERVICE ADDRESS "? ( 13 ,- _ ,, V i LOCATION OF ASSEMBLY !' 1 (' SUPPLY TYPE OF ASSEMBLY /'L NEW INSTALL PSI MANUFACTURER „7c, MODEL i SERIAL �' 1 `- SIZE PVB/SVB CHECK VALVE#1 CHECK VALVE#2 RELIEF VALVE AIR INLET OPENED AT PSID INITIAL TEST HELD AT}LPSID HELD AT �- OPENED AT PSID / PSID OPENED FULLY e CLOSED TIGHT v CLOSED TIGHT a DID NOT OPEN ❑ DID NOT OPEN LEAKED LEAKED n CHECK VALVE HELD AT LEAKED o CLEAND n CLEAND ❑ CLEAND c CLEAND ❑ REPLACED ❑ REPLACED ❑ REPLACED REPLACED t� REPAIR/FINAL HELD AT PSID HELD AT PSID OPENED AT PSID AIR INLET OPENED AT PSID CLOSED TIGHT CLOSED TIGHT a DID NOT OPEN ❑ CHECK VALVE HELD AT LEAKED n LEAKED n ( PASS FAIL NOTES GAUGE p MAKE AND MODEL l�. wL ( �� CALIBRATION DATEZZ 1 1 TESTER G / i �` �� LICENSE DATE 21 REPAIRED BY DATE FINAL TEST BY LICENSE DATE WATER PURVEYOR Nash 8z Son RPM T -- I.A"rl- ICAVATION 208.5o0.9747 Call or Text for an Estimate o� BACKFLOW PREVENTION ASSEMBLY TEST REPORT CUSTOMER NAME SERVICE ADDRESS (-10 VN LOCATION OF ASSEMBLY So SUPPLY +vim TYPE OF ASSEMBLY NEW INSTALL N PSI 90 MANUFACTURER �� ' �y MODEL �Sti 5ERIAL/fjAMg 6/ SIIE PVB/SVB CHECK V*VE 1 CHECK VALVE#2 RELIEF VALVE AIR INLET OPENED AT PSID HELD AT ( PSID HELD AT Z• I PSID OPENED AT PSID OPENED FULLY ❑ INITIAL TEST CLOSED TIGHT CLOSED TIGHT ______ DID NOT OPEN c LEAKED ❑ LEAKED ❑ DID NOT OPEN L CHECK VALVE HELD AT LEAKED r• CLEAND u CLEAND U CLEAND a CLEAND ❑ REPLACED REPLACED REPLACED n REPLACED ❑ REPAIR/FINAL HELD AT PSID HELD AT PSID OPENED AT PSID AIR INLET OPENED AT PSID CLOSED TIGHT CLOSED TIGHT u OID NOT OPEN ❑ CHECK VALVE HELD AT LEAKED n LEAKED a, PASS FAIL NOTES GAUGE N O2,u I MAKE AND MODEL r �{[�J ' CALIBRATION DATE TESTER LICENSE DATE 2- REPAIRED BY DATE FINAL TEST BY LICENSE DATF WATER PURVEYOR t. Nash & Son RPM RE:ALTOR •LANDSCAPING•EXCAVATION- 4. 208.500.9747 4 Call or Text For an Estimate Water File Purveyor: n� d Ufi I i 11�l No: Service Address of assembly�L2 Y t 1 )l da �( Location of assembly on prmiK—rm �— Supply to: (Sp n n K I a Owner of assembly: U (n Owner address: I I�I ba< (t K(clQ z r Pa-Chy =L aU - --- ZIP_ o-1 Manufacturer: L::_ s Model No: Size_L—Serial , 7 / 777 Style: RP O DC)d DCDA O RPDA O PVB O SVB O Orientation New System Pressure 9 Reduced Pressure Principle Assembly Install at this location Y (• PSI Double Check Valve Assembly Check Valve#I Check Valve#2 Relief Valve PVB I SVB INITIAL Held at -L- ( PSID Held at 2--U PSID Air inlet TEST Opened at PSID opened at Closed tight � Closed tight � Did not open O Opened Fully O Leaked O Leaked O Did not open O Check valve Cleaned O Cleaned O Cleaned O held at REPAIRS Replaced O Replaced O Replaced O Leaked O Cleaned O Replaced O FINAL Closed tight Closed tight Opened at Air inlet TEST Leaked O Leaked O Did not open O Check Valve Comments: Initial test by: Chris Nash Date: "I d '2,3 Certi}ication/License# B AT 9 0 4b Pass�& Fail O Repaired/Cleaned by Date.- Final Test by: Date: Certiftcation/License# Pass O Fail V Water service restored? N BAT Fa wngk LW BACKFLOW PREVENTION ASSEMBLY TEST REPORT CUSTOMER NAME /:� LJ SERVICE ADDRESS Vrt LOCATION OF ASSEMBLY G Tj 7, SUPPLY r�' 1!t TYPE OF ASSEMBLY NEW INSTALL PSI (-A- MANUFACTURER �! 1 L MODEL SERIAL f 777 SIZE PVS/SVB CHECK VALVE#1 CHECK VALVE '2 RELIEF VALVE AIR INLET OPENED AT "• i INITIAL TEST HELD AT 2• 1 PSID HELD ATJ��' OPENED AT PSID PSID OPENED FULLY CLOSED TIGHT i CLOSED TIGHT c. DID NOT OPEN LEAKED r: LEAKED DID NOT OPEN CHECK VALVE HELD AT_ LEAKED CLEAND c CLEAND REPLACED REPLACED r. CLEAND [ CLEAND REPAIR/FINAL HELD AT PSID HELD AT P51p REPLACED REPLACED u CLOSED TIGHT a CLOSED TIGHT OPENED AT PSID AIR INLET OPENED AT- PSID LEAKED n LEAKED DID NOT OPEN ❑ CHECK VALVE HELD AT_ PASS FAIL p,; GAUGE u *. MAKE AND MODEL ` CAI IBRATION DAI L L L i (. 1 i � ' C w'� C TESTER LICENSE DATE REPAIRED BY DATE FINAL TEST BY �u (� LICENSE 134 r 7 1 DATE WATER PURVEYOR Lr Nash_.S��Son RPM T LANDSICAVATICIN 208.500.9747 Call or Text for an Estimate {rater , I t. I File Purvevor:_ \)�U I ( Gl a 11 I I l 11 J Vo: Service Address of assembly 05 3 F c r S fi l_Li o C k d Location of assemble on premise �f DYY1� y Gl Supple to: n Ki to Owner of assembly: �✓, L , P U I/ { I I Owner address: 133 EDYZ st le111 q.L {Q d Citi, (,1 V)A lIP 3 �4 .1fanu%ctcture r: L, Model NO: 7 Size Serial _T6 L l v Stele: RP O DC O DCDA O RPDA O PVB#SVB D Orientation New , Reduced Pressure Principle Assentbl System Pressure Install r iu► : l at this location Y � _PSI Double Check Valve Asse»tbli (heck !'alrc#� / Check IValve#12 Rclic/fI'al+e PVBISVB INITIAL Held at PSID Held at PSID Air inlet TEST Opened al PSID opened at ?, Closed tight O Closed tight O Did not open O Opener!F'ullr Q Leaked O Leaked O Did not open a Check valve ('leaned a Cleaned O (Ironed O held at I REPAIRS Replaced O Replaced O Rep/iced D Leaked O Cleaned O Replaced O FINAL Closed tight Closed tight Opened at Air inlet TEST Leaked O Leaked O Did not open O Check Valve Cotnmentc: Initial test by: C��Y �� NG1s Date: 1 2� Certilication/License# 4pi Pass Fai/V Repaired/Cleaned by Date: Final Test by: Data: C'ert ftcatiotr/License# Pass a Fail O Rater service restored? Y N b•CI F 1 sample I W BACKFLOW PREVENTION ASSEMBLY TEST REPORT CUSTOMER NAME /^��(; SERVICE ADDRESS 3 , For e y f le, CZ 6 Cr LOCATION OF ASSEMBLY rr 1 0 v SUPPLY TYPE OF ASSEMBLY NEW INSTALL PSI Ll MANUFA(-iURFR I h MODEL 7-� u ,, SERIAL T 3 SIZE( PVB/SVB CHECK VALVE K 1 CHECK VALVE»2 RELIEF VALVE AIR INLET OPENED AT PSID INITIAL TEST OPENED AT PSID HELD AT PSID !ILLD AT PSID OPENED FULLY Sp CLOSED TIGHT ❑ CLOSED TIGHT DID NOT OPEN LEAKED a LEAKED ❑ DID NOT OPEN ❑ CHECK VALVE HELD AT LEAKED❑ CLEAND CLEAND CLEAND ❑ CLEAND n REPLACED a REPLACED ❑ REPLACED n REPLACED u REPAIR/FINAL HELD AT PSID HELD AT PSID CLOSED TIGHT ❑ CLOSED TIGHT ❑ !)PENEOAT PSID AIR INLET OPENED AT _.PSID LEAKED « LEAKED n DID NOT OPEN CHECK VALVE HELD AT— PASS FAIT Pd ilf' GAUGE p C; �,�.`f MAKE AND MODEL / - s� CALIBRATION DATE (., 1 TESTER LICENSE DATE REPAIRED BY DATE FINAL TEST BY (�J n LICENSE I T, 3k DATE / WATER PURVEYOR , ��f ,G Al Nash 8� Son RPM T - l ANUSIc 208.500.9747 Call or Text for an Estimate die, R� New E:1*ling BACKFLOW ASSEMBLY TEST REPORT � Removtcf L ! Replarement Prop*rtlr Jim Whiteaker Owner Mailing '151 Forest Ridge Rd Blanchard. ID 83804 Adclres% phone 61 g-921-7031 Assem sly 151 Forest Ridge Rd Blanchard, ID 83804 ® 011 P x A O • Y A Q K P 0 A CD G.0 P.. CM P v r. A Q %V rT A O A V V =A,M q" SIZE. 1" MAKE Wilkins MODEL 720A water Pur"Yor StoneriCge Prop Water D;Strrct SarTat EAA6439 Assembly location behind house ;dtz0"r.E1DPJ1Q0SVftA.S1EMV1.y 001LJ11tt.E44VCx `41TIA- TEST r .:►4P G!C INITIAL "Re'"OR(>► _ _ tA? ASSED TEST 4luEF VA►.A ►=ter► oaH.NEL, F AILED 0 RESUL'T's " Pt 'aa AT tl+l cE+ n asp AT Mf ti 1 P$1 BYPA. ttl�eiT 0 no WIT YSTEM PSI CHECK Fl�f �I t� n 0 ,r�� a V50 � � COMMENT- REPAIRS ANDIOP PAR^ At ' is k LEST a cx REPAIRS AFTER rmst REPAIRS R UTrt Q at t �� DATE I►.JF1 f fi N - , PASSE 13 T►�AuaLRrsK,S rW/If�tNri - i��ANi�MA.TIi ArA(�..t.19s A1.4� 11►1�eeAi►./.tkLfGtrit R.,KF.'k KJ�tt rts<�I.+t�rstT�t� rT�! AT1R S}?�,E+� a�wr.9TATF Iettatiu,sloulr I E CALIHRATkI TE 02-28-2023 DETECTOR METER READING 'n r i Dane Yalian 12087777688 !�t,vQ T".v% Darnall Sprinklers C-&vl#cmion it BAT-25372 3172 W Setice Way Post Falls, ID 83854 Gauge try 01191100 •ul wt t : L)ff, ® SERVICE RESTORED 13 FOUND QFF, LEFT OFF i'51 f�Yesf Rya New Existing BACKFLOW ASSEMBLY TEST REPORT Removed Replacement Property Jim Whiteaker Owner Mailing 151 Forest Ridge Rd Blanchard, ID 83804 Address Phone 619-921 -7031 Assembly 151 Forest Ridge Rd Blanchard, ID 83804 Address = R P B A. = D C V A [=] R P D.A O D C D A ® P.V B A a S V B A M A V B. a AIR CAP SIZE 1" MAKE: Wilkins MODEL 720A Water Purveyor stoneridge Prop. Water District Serial # EAA6439 Assembly Location: behind house REDUCED PRESSURE ASSEMBLY DOUBLE CHECKFDIDNO7 A S V B A INITIAL TEST 41 CHECK ET CHECK INITIAL PRESS DROP (AI CHECK #1 PASSED IM TEST RELIEF VALVE TIGHT O EP PRESS FAILED 13 10PENEDAT (B) LEAKED PSID DR"P RESULTS MIN 2 PSID DnATTE�Q �]� SUFFER PSDI 0�/�$/24 A-B - CHECK 02 MIN 3 PSI BYPASS RELIEF VALVE TIGHT O FAILED SYSTEM PSI CHECK PASS 0FAIL 0 LEAKED PSID ❑ ❑ _$1 COMMENTS REPAIRS AND/OR PARTS REDUCED PRESSURE ASSEMBLY D.0 V A P V 9 A t SVBA AFTER TEST n1 CHECK CHECK 41 REPAIRS AFTER RESS DROP (A) TIGHT pgl0 OPENED PRESS REPAIRS 'NELIEF 0 AT DROP DATE ,aENED (B) MIN 2 PSID CHECK #2 PSDI PSDI SUFFER TIGHT PSID A-B 0 PASSED MIN 3 PSI IN COMPLETING AND SUBMI"TTING THIS TEST REPORT.THE TESTER CERT,FiES THAT THE ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE RULES AND REGULATIONS OF THE WATER SYSTENA,AND STATE REGULATIONS GAUGE CALIBRATI N DATE 02-05-2024 DETECTOR METER READING TE TE -ii eNA`U % Tay or Fulwiler 12087777688 State Testers Darnall Sprinklers Certification a BAT-23282 3172 W Setice Way Post Falls, ID 83854 Gauge# 02120756 REPORT RECEIVED BY ❑ SERVICE RESTORED ❑ FOUND OFF, LEFT OFF New E x+sting BACKFLOW ASSEMBLY TEST REPORT Remo-eed on�placemxnf Property Steve Boehland Own*, Mailing 159 Forest Ridge Rd Blanchard, ID 83804 Address Phone 360-431-6347 Assembly 159 Forest Ridge Rd Blanchard, ID 83804 Address aRPhA ®I)C VA C3 0P MA Q:yCDJ1 a I r BA Q4V OAQA V F Q!.-M c.ry SIZE 1" MAKE Febco MODEL 850 wae.r puTv*yor Stonemige Prnp. Water District HC23625 Ass,embty Location. Left side of House M13UCEDPRltI*t,0 E A"t%i, rm-Warr. cf-eCk INITIAL TEST *I C.114ECIL INITIAL PMsS Dww PASSED TEST ow-LtEs VALVE .'F t�1tt't t=Rtcs]S FAILLD 13 RESULTS WEtvE.^.AT �S iu� ; usa*b 13 _ A DO-w DATE �c A !! - CdetlC A1' BYPASS 11001 �a CHECK ftELIV VAL W. ® 2.2 osr Nrrr •Aiuo S Y�SnT EM PSI COMMENTS REPAIRS ANDIOR PARTS Ci�n r ttE!lrs t A3AElk6l.r Ct C V A P 4-9 A. 5 V p A TEST AFTER st C�Cx C,rtEt_x illREPAIRS AFTER F a�sac�s;,r ... '4I tc��t PSM ofts4D 61"Lzb REPAIRS 0 A tAkov DATE OPFAIM �I i pile QWC9 02 PM fit, afle low Epp ° 3 raF PASSED E3 dW CilwRtaETWO AMA fir"TLST MPOM.Tt#TEMR CVRTVlb r qAT tra,ASUMI .r•"IMF%t31 TED AM&WNrA&%"ift ACCOMMM"wY"Au APKt"&J!1,l<FtULta AND REGULATsr.A►'><C0 THE 0 AISM SV SITM AM STATE REOULATIOIFIE GAUGE CAL 16RAT ION ELATE 02-28-2023 DETECTOR MET ER READING 77, James Williams 12087777688 sIK: Tay,,,; Darnall Sprinklers Cer:tiFca sour Bat-16583 3172 W Setice Way Post Falls, ID 83854 Gauge# 12091184 ® SERVICE RESTORED ❑ FLOWND OFF LEFT OFF F7 New MExisting BACKFLOW ASSEMBLY TEST REPORT 0 Removed Replacement Property Steve Boehland Owner Mailing 159 Forest Ridge Rd Blanchard, ID 83804 Address Phone: 360-431 -6347 Assembly 159 Forest Ridge Rd Blanchard, ID 83804 Address I--] RPBA. ® D.CVA a RPD.A [::] DCDA = PV BA [::] SVBA = .AVB =AIRGAP SIZE 1" MAKE: Febco MODEL: 850 Water Purveyor Stoneridge Prop. Water District Serial # HC23625 Assembly Location: Left side of House REDUCED PRESSURE ASSEMBLY DOUB-E CHECK -1 V B A : S V B A INITIAL TEST 1:1 CHECK AIR INLET CHECK INITIAL PRESS DROP (AI CHECK #i PASSED IM TEST RELIEF VALVE TIGHT 01 •9 OPENED PRESS FAILED 13 RESULTS OPENED AT MIN 2 PSID (B) -EAKED Q PSID AT DROP D/nATTCE/��pp SUFFER PSDI PSDI Qfi'iJ.Q_�-4 A-B CHECK 02 BYPASS MIN 3 PSI CHECK RELIEF VALVE TIGHT ® 2,3 DID NOT FAILED SYSTEM PSI OPEN PASS 0 FAIL [3 LEAKED PSID Q 13 8L COMMENTS REPAIRS AND/OR PARTS REDUCED PRESSURE ASSEMBLY D.0 V A P V.9 A S V 6 A AFTER TEST as CHECK CHECK 01 REPAIRS AFTER PRESS DROP (A) TIGHT PSI,' OPENED PRESS REPAIRS RELIEF 0 AT DR`_F DATE OPENED (8) MIN 2 PSID CHECK e2 PSDI =5C1 BUFFER TIGHT p A-B � 0S1d PASSED [3MIN 3 PSI IN COMPLETING AND SUBMITTING THIS TEST REPORT,THE TESTER CERTIFIES THAT THE ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE RULES AND REGULATIONS OF THE WATER SVSTENI,AND SATE REGULATIONS GAUGE CALIBRATI N DATF 02-05-2024 DETECTOR METER READING TE TE i NATU Tay or Fulwiler 12087777688 State Testers Darnall Sprinklers Certification # BAT-23282 3172 W Setice Way Post Falls, ID 83854 Gauge# 02120756 REPORT RECEIVED BY ❑ SERVICE RESTORED 0 FOUND OFF, LEFT OFF Water (( File Purveyor. i f�'n e r I o a L U-h� I n d No: Service Address of assembly ? "I T I Q n ci fT Location of assembly on premise �Myyr S►,/,ply Jo: l� DY I(1��k1-1 Owner of assembly: U 11e lV b Owner address: a. )O±o" ZIP 3 11unuJuc toter: �n/ L(-',n'2 Model No: g PP AL i Size Scria/ Style: RP O DC DCDA O RPDA O P1'B O S1 B O Orientation New S�stenr Pressure Instal/ r Reduced Pressure Principle Assetnblt at this location Y Nn PSI Double Check Valve Assenibli F- Chec�V'alye# Check 1'ahe#Z Relief Padre PVBISVB _j INITIAL Held at / PSID Held at PSID Air inlet TEST Opened at PSID opened at Closed light 56- Closed fight Did not open O Opened Fu111, O Leaked O Leaked O Did not open O Check valve Opened O Cleaned O Cleaned O held at REPAIRS Replacer)O Replaced O Replaced O Leaked O Cleaned O Replaced O FINAL Closed tight Closed tight Opened at Air inlet TEST Leaked O Leaked O Did not open O Check Valve Comments: Initial test by: C h a s Nash Date: ^I V-2 Certification/License# Dot 1 Pass Fail O RepairedlCleaned by Data: ritutl Test ikw Date: Certification/Licert.ce# Pass O Fail Water service restored. Y N BAT Form sample LW BACKFLOW PREVENTION ASSEMBLY TEST REPORT CUSTOMER NAME i SERVICE ADDRESS ( _ r_� I f� >� ` l �� "S C_ � LOCATION OF ASSEMBLY SUPPLY ! TYPE OF ASSEMBLY NEW INSTALL PSI MANUFACTURER 1u ^!� MODEL _ SERIAL L/�"S`LU SIZE PVB/SVB CHECK VALVE#1 CHECK VALVE#2 RELIEF VALVE AIR INLET OPENED AT PSID _ HELD AT ,r PSID HELD AT �� OPENED AT PSID PSID tt OPENED FULLY INITIAL TEST CLOSED TIGHT CLOSED TIGHT � DID NOT OPEN LEAKED n LEAKED n DID NOT OPEN u CHECK VALVE HELD AT LEAKED❑ CLEAND c: CLEAND n CLEAND CLEAND,q REPLACED ❑ REPAIR/FINAL HELD AT PSID HELD AT PSID REPLACED REPLACED CLOSED TIGHT a CLOSED TIGHT u OPENED AT PSID AIR INLET OPENED AT PSID LEAKED r LEAKED n DID NOT OPEN CHECK VALVE HELD AT PASS FAIL NOTES GAUGE tr C) �,C C MAKE AND MODEL 1'1 I CALIBRATION DATE 4' TESTER r L.� L LICENSE DATE L.� ) 7 REPAIRED BY DATE FINAL TEST BY LICENSE DATE WATER PURVEYOR Nash & Son RPM I ANDCICAVArION i1 . v 208.500.9 747 Call or Text for an Estimate 4ater, (S�O . File Purve►or: No: Service Address of assemble' �"f C,n Q rd Cfi Location of assembly on premise a h T Supply to: Owner of assembl►�: rq Owner address: "1 (,'� Q�'(1� �.1 Citr I �� h �i{r� ZIP 1lunufacturer: Model No: �j Size Serial N 13 l Z Str1e: RP O DC�- DCDA O RPDA O PVB O SVB O Orientation New System Pressure Installati ? Reduced Pressure Principle Assenrbll at this location Double Check Valve Assemble PSI Che�ralve# Check Valve#2 Relief 17alve Tj PI B/.S1'B _j INITIAL Held at , PSID Held at 1 PSID Air inlet Opened at PSID opened titTEST Closed tight 6( Closed tight Did not open O Opened Full.O Leaked O Leaked O Did not open O Check valve Cleaned O Cleaned a Cleaned O held at REPAIRS Replaced O Replaced O Replaced O Leaked O Cleaned O Replaced O FINAL Closed tight Closed tight Opened at Air inlet TEST Leaked O Leaked O Did not open O Check 1'alve Comments: Initial test b1: Ch r S N a s►� Date: Certification/License# 2 `f Y/ Pass Fail 0 RepairetIlCleaned hh Date: Final Test ki% Date: Certification/License# Pass a Fail O {f'aler service restored Y N HAI Fo sample I N Customer/Business Name: N illovi Hanna Date: 5/9/2024 49 1lanaford Ct A-ccembly Service Address: Blunchard, ID 83804 Location of Assembly: back R, R fret walk Type of Hazard Controlled: J— Assembly Info-Make: cbG� S p Serial#� tl RPBA RPDA 1 VA DCDA PVB SVB Size(In): Line Pressure(PSI): 7 d installation: Horizontal: N Vertical: VU VD Other: New: Y '( N J Replaces Serial #: Cheek Valve pl Cbedt Valve#2 Relief Valve PVBISVB Shot OIIVaIva _ Initial d Id at 2.Q PSID d Id at PSID ❑ Opened at ❑ Opened at �1 Test . C'I. fight Cloxd Tight PSTD PSID Closed Tight [] Leaked ❑ Leaked ❑ Opened Fully ❑ Opened Fully ❑ Did Not Open ❑ Did Not Open Leaked ❑ ❑ ❑ Check held at rslD � ❑ Leaked ❑ CLEANED ❑ CLEANED ❑ CLEANED ❑ CLEANED CLEANED ❑ ❑ ❑ REPLACED: ❑ REPLACED: ❑ REPLACED: ❑ REPLACED; ❑ Disc ❑ Disc ❑ Disc ❑ Poppet/Float REPLACED ❑ ❑ ❑ Spring ❑ Spring ❑ Spring ❑ Air Inlet Spring ❑ Guide ❑ Guide ❑ Guide ❑ Cheek Disc ❑ Seat ❑ Seat ❑ Seat ❑ Check Spring A ❑ Hinge Pin ❑ Hinge Pin ❑ O-Rings) ❑ O-Ring(s) IY ❑ Module ❑ Module ❑ Module ❑ Guide a ❑ El El El �4 NOTLS: F711aI Closed Tight ❑, losed Tight ❑ Opened At Air Inlet PSTD Shut Off Valves 41 #2 Tat I-D--PSID PSID PSID CKValve PSID Closed Tight [.�-- NOTE:Purveyor must be notified within 24 bra of any beckflow prevention assembly left in a falled(non-passlne)condition. Tester's Name(please print):DAN ROSE ID BAT License# : 23366 Company Name: SPRINKLERS NORTHWEST Expiration Date:4/20/2025 Company Phone: 208-818-8838 Email: Test Equipment Make& Model: MAKO MK5 Serial#:02AC22040141 Calibrated By: MAKO Calibration Date:09/21/2023 1 cenify the asaetnbly was tested In scordance with U.S.C.teat protocol and was in working coodnion. t Resulb: Passed Cry Failed ❑ Aamobly as Left: Watct Service Re9rnsdQ1rBAT Tag Attachedffl"— siv4a,dwTester ooc CeavofRetwn to: Customer/Owner C3 Water Purveyor ❑ Licensed Tester Water Purveyor: ;c Llistoincr;Business Nainc: o r)4 (An-}�CI J rn�►� gate: 8-q - 2 As.rmhlt ticnicc Address: 1 /I CJrd . I.tication of.4s ccmhly A I/ 1c ner n+ hw e _I',Pe of IIward('eintmlled: Avwnthl, inlir Make: C Mlxkl a: ,Z('A u Serial a:_V�p 21 cj Z 2 RP11A ORPDA❑De1':([3Po ;1Pv.. ❑svn❑ SW(In): ( t l Line Prcccure(PSI): —1 Q lnstallanon Nnrnonial ,,0v �N Venicul 11 DVD Othr:e i.^:iei New (h(.I1) ❑N Replacer SerialN. Check Vahv MI Check Valve N2 Relief Valve PVBNFVR Shot off vab W Initial [] lield al PSrn l] Fleld at PSID ❑ Opened at ZI Au Inlet opened at 1 est ❑ Closed Tight ❑ Closed Tight PSID Kit) Closed Tight �I caked ❑Leaked [3 Opcncd Fully ® Opened Fully ❑ Did Not Open Did Not Open Leaked Check held at Z'H PSrD Leaked REPAM ❑ (LEANED ❑ CI.EANED 11 CLEANED ❑ CLEANED CLEANED ❑ ❑ DATE: ❑ REPLACED REPLACED ❑ REPLACFD: ❑ RULACEU ❑ Disc Disc Disc ❑ Poppet Float REPLACED 1,pring Spring Spring ❑ Au Inlet Spring ❑ Guide ❑ Guide ❑ Guide ❑ Check Disc ❑ Seat ❑ Seat ❑ Seat ❑ Check Spring ❑ I tinge Pin ❑ Binge Pin ❑ O•Ring(s) ❑ O-Rings) ❑ Module ❑ Module Module Guide I foal Closed Tight Closed Tight Opened At An Ink PSID ShuIUtTVal,es .I ., 1 est PSID [,sit) PSID CK Vats I'Sin Closed Tight ❑ ❑ NOTE:Pun'eyor must be notified within Iwo(2)business days of anp backflow prevention assembly left in a failed(non-passing)condition. "Testees Name(please print): Christopher Holtz II)HAT License d: 25230 Company Name: Aquanetix Irrigation Services- ENpirution Date: 11/30/23 Company Phone: 208-967-4856 Fay#: Test Equipment Make& Model Midwest 845-5 _ Scriul fs: 04221712 c:alibratiiai Dane: 3/2W23 C'aUbratcd By Uriel V. Branom Ind. _ I certify the sc fly Was tested in dCCinddntc will%IJS0:C(YYIR I01111 edition lest Procedure. Test I'a .ct ('ailed Atutenibly as Left: Scn ice Restored �J HAT halt Attached - L-( - 23 SronaWreofTc ter bale py or Report to: -Cwtuuu r44Wrcr Water Purveyor License: Tcste 4 %Liter 1'unryor: - -- —-- — f uy at Cowl d'Alene Wutri mp umicni onicc ut('iu.+(owiv wn Cmirol Apiwo%ed Bo�kllow Aneniwy rest Repun full �v I 11a✓-4O v-J kA Customer/Business Name:Wyant Lauterman Uate 08-21-24 Assembly service Address:69 Hanaford Blanchard, ID 83804 Location of Asac;mbly;Westside of house Type of Hazard Controlled: Assembly info- Make: Wilkins Model# 720-AU serial#. T627922 I,tt,io RPBA RPDA DCVA DCDA (t2) SVB Size(In): 1 tt Line Pressure(PSI1: 50 Installation: Horizontal: Y N Vertical: VU V1) lhhcr I,1"Icl New: Y O Replaces Scrial#; Check Valle#1 Check N'al%v 02 Relief Valve PVB/SN'B Shut Off Valve% #1 #' Initial ❑ Held ai I'SII i ❑ Held at PSID ❑ Opened at ❑ Opened at Test ❑ Closed Tight ❑ Closed Tight PSID 1_8__PSID Closed Tight ❑ LvAed ❑ Exalted ❑ Opened Fully ® Opened Fully ❑ Did Not Open ❑ Did Not Open lacked ❑ ❑ ® Cheek held at 2.4 PSID ❑ Leaked ❑ CI.EANED ❑ CLEANED ❑ CLEANED ❑ CLEANED CLEANED ❑ ❑ ❑ REPLACED: ❑ REPLACED: ❑ REPL.ACT-D) ❑ REPLACED; ❑ Disc ❑ Dise ❑ Disc ❑ Poppet/Float REPLACED ❑ ❑ ❑ Spring ❑ Spring ❑ Spring ❑ Air Inlet Spring ❑ Guide ❑ Guide ❑ Guide ❑ Check Disc ❑ Seat ❑ scat ❑ Seat ❑ Check Spring C ❑ Hinge Pin ❑ Hinge Pin ❑ 0-Ring(s) ❑ O•Ring(s) at ❑ Mande ❑ Mtxlulc ❑ M1xlUIC ❑ Guide NOTMS: Final ❑ C'loxd Tight ❑ Closed Tight ❑ Opened At Air Inlet PS►D Shut Olf Val\rs #1 #2 Test PSID PSID PSID CK Valve PSID Closed Tight ❑ ❑ WATER PURVEYOR MUS"I Il l m i NFIED NO LATER THAN TWO(2)BUSINESS DAYS FOLLOWING A FAILED TEST. Tester's Name(please print): Christopher Holtz ID BAT License#: 25230 Company Name: CSI Landscape Expiration Date: 11-30-24 Company Phone: 5092908920 Fax#: N/A Test Equipment Make&ModaMidwest 845-5 scriai#: 04221712 Calibrated By: Calibration Date: 02-26-2024 I certify the asscttthly w a.tested in acordance with U.S.C.test pago eol and was in working condition. T Results: Pas d IM Fuilni ❑ Assembly am Left Water Service Re.ttrtxt® 8A f Tap Attached® 08-21-24 S u ul Tc.ter Duce Copv of Rentirt In: ('u.t,mierK)wner ❑ Water Puncvor ❑ Licensed Tester ❑ Water Purveyor: Stoneridge Utilities M1.M11 I&J"I Rcglunni Wader Ptin CH-r% Bwktlk.w A�wmbl)TL t Reptxt CSI Landscape 9116 E Sprague Ave Spokane Valley,WA 99206 5092908920 LJ New Existing BACKFLOW ASSEMBLY TEST REPORT Removed Replacement Property David Unruh Owner Mailing 106 Hanaford Rd Blanchard, ID 83804 Address Phone 209-605-2723 Assembly 106 Hanaford Rd Blanchard, ID 83804 Address ORPBA ® D C V A [=] R P II A O D C D A [=] P V BA [=] S V B A = A V B O Aik �.AP SIZE 1 " MAKE Wilkins MODEL 950XL Water Purveyor Stoneridge Prop. Water District Serial # 3325148 Assembly Location meter REDUCED PRESSURE ASSEMBLY DOUBLE CHECK [AIR P V B A S V G A INITIAL TEST at CHECK CHECK at INLET CHECK PASSEDINITIAL PRESS DROP (A) TIGHT TEST RELIEF VALVE 102.2PENED PRESS FAILED 13 RES ULTc, OPENED AT LEAKED PSID (B) A DROP MIN 2 PSID 0 . ,ATE BUFFER PSDI PSDI 05 f 6-/23 A-B = CHECK >r2 BYPASS MIN 3 PSI CHECK RELIEF VALVE TIGHT 02.8 DID NOT p;, It SYSTEM PSI r'PUN PASS ❑ FAX 0 FA LEAKED E3 PS'D ❑ ❑ 55 COMMENTS REPAIRS AND/OR PARTS =tEDUCED PRESSURE ASSEMBLY D C V A P V B A ! S F :t TEST AFTER rs1 CHECK CHECK b1 REPAIRS AFTER PRESS DROP (AI TIGHT PSID OPENED PRESS REPAIRS RELIEF a AT DROP DATE OPENED (8) MIN 2 PSID CHECK tat PSDI PSDI BUFFER TIGHT PSID A- B 13 PASSED MIN 3 PSI IN COMPLETING AND SUBMITTING THIS TEST REPORT,THE TESTER CERTIFIES THAT THE ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE RULES AND REGULATIONS OF THE WATER CYSTFM,AND STATE REGULATIONS GAUGE CALIBRATION DATE 02-28-2023 DETECTOR METER READING rE R SIGNATLIRE J mes Williams 12087777688 state Testers Darnall Sprinklers Certification # Bat-16583 3172 W Setice Way Post Falls, ID 83854 Gauge # 12091184 REPORT RECEIVED BY ® SERVICE RESTORED ❑ FOUND OFF. LEFT OFF F7 New MExisting BACKFLOW ASSEMBLY TEST REPORT 0 Removed F7Replacement Property David Unruh Owner Mailing 106 Hanaford Rd Blanchard, ID 83804 Address Phone 209-605-2723 Assembly 106 Hanaford Rd Blanchard, ID 83804 Address 0 R P B A ® D VA O k P D A [:] D C D A [:] P.V BA [:I S V B AC:]A �I B a AIR GAP SIZE 1 " MAKE: Wilkins MODEL: 950XL Water Purveyor stoneridge Prop. Water District Serial # 3325148 Assembly Location: meter REDUCED PRESSURE ASSEMBLY DOUBLE CHECK D 'v B A / S '/E aINITIAL TEST 91 CHECK AIR INLET CHEC INITIAL PRESS DROP (A) CHECK 01 TIGHT PASSED TEST RELIEF VALVE ®2.2 OPENED PRESFAILED RESULTS OPENED AT MIN 2 PSID (9) LEAKED ❑ PS'D AT DROP,,] DnATTE�Q BUFFER PSDI DSDI Qfi/M-i2-4 A- B - CHECK 02 BYPASS MIN 3 PSI CHECK RELIEF VALVE TIGHT ® 2 DID NOT FAILED SYSTEM PSI PASS 0 FAIL a �- OPEN 13 ❑ O� LEAKED PSID O COMMENTS REPAIRS AND/OR PARTS REDUCED PRESSURE ASSEMBLY D.0 V A P V 9 A SVBA AFTER TEST 41 CHECK CHECK 01 REPAIRS AFTER PRESS DROP (A) TIGHT PSID OPENED PRESS REPAIRS RELIEF ❑ AT DROP DATE OPENED t8 MIN 2PSID CHECK 02 PSDI Psnl BUFFER TIGHT pglD A.B PASSED 0 MIN 3 PSI IN COMPLETING AND SUBMITTING THIS TEST REPORT,THE TESTER CERTFIES THAT THE ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE RULES AND REGULATIONS OF THE WATER SVSTEfd AND STATE REGULATIONS GAUGE CALIBRATI N DATE 02-05-2024 DETECTOR METER READING -f_TE ..I NATL Taylor Fulwiler 12087777688 State Testers Darnall Sprinklers Certification #BAT-23282 3172 W Setice Way Post Falls, ID 83854 Gauge # 02120756 REPORT RECEIVED BY ❑ SERVICE RESTORED ❑ FOUND OFF, LEFT OFF N'aler CSfi Cc 1fi-C file Punre No: Service Address of osse mhlt' I T 1 �� D t2 r �1 Location of assemble on preml Ae Supple to: Y 1 n Owner of assemhl,•: y U 1 1 Owner address: Cih• ZIP Q ear 11unnlaclnrer: v, �% , , Model No: Size Serial Sole: RP C DC O DCDA 0 RPDA O PVB SVB O Orientation New Sestem Pressure Installation? Reduc erl Pressure Principle.�.csetnh/, at this location Y U sU PSI Double Check Valve Assembly TT hc ch I ulrc 1 Check Valve#2 Relic/ I u/Lc PVB/SVB -11 INITIAL Held at PS7D Held at PSID Air hill{ TEST Opened at P.S/D opened u1 I� Closed tight O Closed tight O Did not open O Opened hill,, Leaked O Leaked O Did not open O Check valve Cleaned O Cleaned a (leaned O held at—I— REPAIRS Replaced O Replaced D Replaced O Leaked O (leaned O Replac•cd O FINAL Closed tight Closed right Opened at Air inlet TEST Leaked O Leaked O Did not open O Check Valve Comments: Initial test by: j2 ( Date: CertificatiomlUcense# Pass Fail O Repaired/Clea►ted by Date: Final Test bv: Date: Certification/License# Pass O Fail O Water service restoredW N BAT Form w plc LAV BACKFLOW PREVENTION ASSEMBLY TEST REPORT CUSTOMER NAME FVl I? SERVICE ADDRESS /C, /��7�� ✓ `� [! '��i .t L ._r �~ i �'[ia LOCATION OF ASSEMBLY 1 �� SUPPLY TYPE OF ASSEMBLY V NEW INSTALL PSI MANUFACTURER W I MODEL v SERIAL T--y y y 7 S12E PVB/SVB _ CHECK VALVE#i CHECK VALVE#2 RELIEF VALVE AIR INLET OPENED AT 5. O PSID INITIAL TEST HELD AT PSID HELD AT PSID OPENED AT PSID OPENED FULLY 4 CLOSED TIGHT ❑ CLOSED TIGHT c DID NOT OPEN u DID NOT OPEN �., 1 LEAKED a LEAKED ❑ CHECK VALVE HELD AT:a 1— LEAKED❑ CLEAND n CLEAND CLEAND o CLEAND n REPLACED q REPLACED REPLACED REPLACED r, REPAIR/FINAL HELD AT PSID HELD AT PSID CLOSED TIGHT �-: CLOSED TIGHT a OPENED AT PSID AIR INLET OPENED AT PSID CIO ISED TIGHT n LEAKED - DID NOT OPEN ❑ CHECK VALVE HELD AT (PASS FAIL NOTES GAUGE p �, � �� MAKE AND MODEL � f � 6 - � � ��i� <-� CALIBRATION DATE 5 TESTER LICENSE DATE i. v , REPAIRED BY DATE FINAL TEST BY U LICENSE t T C t. C DATE WATER PURVEYOR C� U R'L V i ,.1tV t flash & Son RPM RFAI TOP -I AN 11C1'A"I"'- - r v,AVATION J V 208.500.9747 Call or Text for an Estimate �ti ile Purveeyor. n e r l d 6 (, U I I I f ( S FYo.' Service Address of assembly 2 In n n h rd r Location of assembly on premise L•e 44- 0 �— Supply to: Owner of assembly: Owner address: ILO Zip QlLi Manufacturer. Model No: ZO Sim Serial q,)Gj U Z/ Style: RP DC O DCDA D RPDA O PVB O SVB O Orientation New System Pressure Install Reduced Pressure Principle Assembly at t is location Y � 610 PSI Double Check Valve Assembly Check Valve# I Check Valve#2 Relief Valve PVB/SVB -T INITIAL Held at O PSID Held at L�• PSID _ Air inlet Opened at PSID opened at TEST Closed tight Closed tight 4 Did not open O Opened Fully O Leaked O Leaked O Did not open O Check valve Cleaned a Cleaned O Cleaned O held at REPAIRS Replaced O Replaced O Replaced O Leaked a Cleaned a Replaced O FINAL Closed tight Closed tight Opened at Air inlet TEST Leaked O Leaked 0 Did not open O Check Valve Comments: Initial test b y: Chris I� Q S r 1 Date: I d 2 J Certification/License# 13 AT M 4 Lb Pass p Fail C7 Repaired/Cleaned b{• Date: Final Test bV: Date: Certification/License# Pass a Fail V Water service restored? N RAI F—sample t N' BACKFLOW PREVENTION ASSEMBLY TEST REPORT CUSTOMER NAME SERVICE ADDRESS LOCATION OF ASSEMBLY SUPPLY jr f f Ct. TYPE OF ASSEMBLY NEW INSTALL PSI C MANUFACTURER MODEL 7 [� SERIAL i/ L c 2 SIZE PVB/SVB CHECK VA�E#1 CHECK VAL E#2 RELIEF VALVE AIR INLET OPENED AT PSID INITIAL TEST HELD AT`�_P510 HELD AT 1 OPENED PSID PSID u � OPENED FULLY r CLOSED TIGHT n CLOSED TIGHT @ DID NOT OPEN n LEAKED a LEAKED ❑ DID NOO T OPENN -� CHECK VALVE HELD AT LEAKED c CLEAND o CLEAND a CLEAND r.: CLEAND n REPLACED ❑ REPLACED o REPLACED REPLACED REPAIR/FINAL HELD AT PSID HELD AT PSID OPENED AT -PSID AIR INLET OPENED ATi_ _PSID CLOSED TIGHT CLOSED TIGHT LEAKED ❑ LEAKED ❑ DID NOT OPEN ❑ CHECK VALVE HELD AT ASS FAIL NOTES GAUGE>rIr a.`� 6'L'` MAKE AND MODEL j' C�'4✓!�f 5 CALIBRATION DATE ? ,z TESTER L�l ,^ i;4 1 LICENSE �.L.7 DATE / 1 REPAIRED BY DATE FINAL TEST BY LICENS[ DATE WATER PURVEYOR Nash l� Son RPM T "•LAPfD :� IAVATI.N 208.500.9747 Call or Text for an Estimate Water h File Purveyor: n �T U� 1 I I t j No-- Service Address of assembly o o l l Cl n rd (-I- Location of assembly on pmnise D 1`1 &pply to: CSC n n K I a Owner of assembly: tQ Ct 1 ) C U Owner address: ,) D 0 rl n 0 fy r d CWy IM L b L 19,1 ZIP `L K0 A Manufacturer: (mac, Model No: OG"7 t,j 9 �Size_ ISMW 7f j&3 Style: RP C DC C DCDA C RPDA C PVB C SVB C Orientation New System Pressure Install 9 Reduced Pressure Principle Assembly at this location Y � PSI Double Check Valve Assembly Check Valve#I Check Valve#1 Relief Valve PVB/SVB INITIAL Held at PSID Held at _PSID Air inlet Opened at PSID opened at TEST Closed fight 0— Closed tight . Did not open O Opened Fully O Leaked C Leaked C Did not open O Check valve Cleaned C Cleaned C Cleaned O held at REPAIRS Replaced C Replaced C Replaced C Leaked C Cleaned O Replaced O FINAL crosed4w Closed tight Opened at Air inlet TEST L"W 12 Leaked O Did not open O Check Valve Comments: Initial test by: Chris N a s h Date: "I V J3 Certyl-cation/License# B Pass�ft Fail O Repaired/Cleaned by Date: Final Test by: Date: CM#Zcadon/Lic ewe# Pass C Fag C Water service restored? N BAT Fete emph LW BACKFLOW PREVENTION ASSEMBLY TEST REPORT CUSTOMER NAME n , i1^ l- SERVICE ADDRESS �, (y)L) Lt v j z g LOCATION OF ASSEMBLY -r e- J Q SUPPLY TYPE OF ASSEMBLY p NEW INSTALL PSI 7 v MANUFACTURER Lj a ff MODEL C)L; 7 T SERIAL - 1 SIZE 1 ' I` PVB/SVB CHECK VALVE#1 CHECK VALVE#2 RELIEF VALVE AIR INLET OPENED AT PSID INITIAL TEST OPENED AT PSID HELD AT 90 I PSID HELD AT 7, I PSID OPENED FULLY e CLOSED TIGHT d CLOSED TIGHT d DID NOT OPEN o LEAKED ❑ LEAKED a DID NOT OPEN CHECK VALVE HELD AT LEAKED a CLEAND n CLEAND ❑ CLEAND ❑ CLEAND a REPLACED a REPLACED u REPLACED c REPLACED ❑ REPAIR/FINAL HELD AT PSID HELD AT PSID CLOSED TIGHT a CLOSED TIGHT c OPENED AT PSID AIR INLET OPENED AT-PSID LEAKED o LEAKED ❑ DID NOT OPEN ❑ CHECK VALVE HELD AT PASS FAIL NOTES GAUGE# � 1 ( MAKE AND MODEL /�, e L � CALIBRATION DATE >' l TESTER LICENSE DATE REPAIRED BY DATE FINAL TEST BY U LICENSE I r 2 1 S DATE / WATER PURVEYOR e_ lk 1 `� v r., G/1 IF Nash & Son RPM RFALTOR^- S1CAVA7ION 208.500.9 747 Call or Text for an Estimate Customer/Busines%Name: Ed & Brenda Brown Date: 5/11/2023 317 Hanaford Road Assembly Service Address: Blanchard, ID 83804 Location of Assembly: R side Type of Hazard Controlled: 1 Assembly info-Make: WILKINS MODEL: 950 XL Serial# 299499 RPBA RPDA DCDA PVB SVB Size(In): Line Pressure(PSI): Installation:Horizontal: N Vertical:VU VD Other: New: Y I" Replaces Serial Check Valve Nl Cheek Valve NI Reiw Valve PVB/SVB _36nt OH Valves / �� — Initial Held at PSID Held at/ `� PSID ❑ Opened at ❑ Opened at 1 r/2 Test '*�Iclosed Tight Closed Tight PSID PSID Closed Tight ❑ Leaked Leaked ❑ Opened Fully ❑ Opened Fully ❑ Did Not Open ❑ Did Not Open Leaked ❑ ❑ ❑ Check held at i PSID i _ ❑ Leaked ❑ CLEANED ❑ CLEANED ❑ CLEANED ❑ CLEANED -- CLEANED ❑ ❑ ❑ REPLACC: ❑ BBPLACED: ❑ RIr!I QP: ❑ REn Am: ❑ Disc ❑ Disc ❑ Disc ❑ Poppet/Float REPLACED ❑ ❑ ❑ Spring ❑ Spring ❑ Spring ❑ Air Irdet Spring ❑ Guide ❑ Guide ❑ Guide ❑ Check Disc ❑ Seat [] Seat ❑ Seat ❑ Check Spring G ❑ Hinge Pin ❑ Hinge Pin ❑ O-Rings) ❑ O-Ring(s) ❑ Module ❑ Module ❑ Module ❑ Guide a D-- , — ❑ __--- ❑ ❑ --- MOTES: -- - - Final [Q CI Tighl Closed Tight ❑ Opened At Air Inlet PSID Shut Off Valves ' #1 #2 Test —� PSID N- P— PSID CK Valve PSID Closed Tight NOTE:Purveyor trust be nottlied within 24 bra of any backflow prevention assembly left in a failed(nos-passing)condition. Tester's Name(please print):HAYDEN TANNER ID BAT License#: 23903 Company Name: SPRINKLERS NORTHWEST Expiration Date:05/01/24 Company Phone: 208-818-8838 Email: Test Equipment Make&Model: MIDWEST 845 Serial#:03141084 Calibrated By: B.A.T.SUPPLY Calibration Date:09/24/22 I certify the assembly was tested in acordance with U.S.C.tent protocol and waa in working condition. Test Results: Passed 1-Q1— Failed ❑ Ass embly as eft: Water Service Restored BAT Tag Anached� ZZ Siaeoue of?ealrr 1 Due Copt/of Report to: customer/Owner �] water Pt of ❑ Licansed Tester Water Purveyor: STONERIDCE Customer/Business Name: Ed & Brenda Brown Date: 5/17/2024 317 llanaford Rd Assembly Service Address: Blanchard, ID 83804 Location of Assembly: R side Type of Hazard Controlled: c Assembly Info-Make: Wilkins/950XL Serial# 299499 RPBA RPDA CV t DCDA PVB SVB Size(In): Line Pressure(PSI): / Installation:Horizor4-- Y� N Vertical: VU VD Other: New: Y Replaces Serial #: Cheek Valve#I J heck Valve#2 Relief Valve_ PVB/SVB Shut OH Valve$ #1 #2 LnitialHeld at IDPSID Held at f/ PSID ❑ Opened at ❑ Opened at Test dosed Tight Closed Tight PSID I PSID Closed Tight ❑ Leaked ❑ Leaked ❑ Opened Fully ❑ Opened Fully ❑ Did Not Open ❑ Did Not Open Leaked ❑ ❑ ❑ Check held at PSID I I ❑ Leaked ❑ CLEANED ❑ CLEANED ❑ CLEANED ❑ CLEANED CLEANED ❑ ❑ ❑ REPLACED: ❑ REPLACED: ❑ REPLACED: ❑ REPLACED: ❑ Disc ❑ Disc ❑ Disc ❑ Poppet/Float REPLACED ❑ ❑ ❑ Spring ❑ Spring ❑ Spring ❑ Air Inlet Spring ❑ Guide ❑ Guide ❑ Guide ❑ Check Disc i ❑ Seat ❑ Seat ❑ Seat ❑ Check Spring ❑ Hinge Pin ❑ Hinge Pin ❑ O-Ring(s) ❑ O-Ring(s) G ❑ Module ❑ Module ❑ Module ❑ Guide aW C NOTES: - - -1— ' r� Final fr'Closed Tight f/i Closed ighl ❑ Opened At j Air Inlet PSID Shut Off Valves #1 #2 Tat PSID PSID PSID }. �'� t - _PSID Closed Tight , NOTE:Purveyor must be notified within 24 brs of any backtlow prevention assembly lift In a fail( on-panin¢)condition. Tester's Name(please print): RICHARD STAFFORD ID BAT License N 181 ai Company Name: SPRINKLERS NORTHWEST Expiration Date: 10/25/2024 Company Phone: 208-818-8838 Email: Test Equipment Make&Model: MIDWEST 845 Serial#:02191467 Calibrated By; B.A.T.&SUPPLY Calibration Date:09/21/23 I cettit.V the assanti mated in&cords=with U.S.C.test protocol and was in working coaftion Test Results: Pm Failed ❑ Assembiv as Left: Water Service Resuved ass T Tag Anechedd �iynwte orTmv - Diu Copy of Report lo: Customevlowna ❑ water Purveyor ❑ Licensed Tema ❑ Water Purveyor: STONERIDGE 15 I4axic4t rd Customer/Business Name: Heather.lolulson Date: 5/11/2023 115 Hanaford Rd --- -- Assembly Service Address: Blanchard, ID 83804 Location of Assembly: L SIDE IN BED Type of Hazard Controlled: Assembly info-Make: Serial# A RPDA DCVA DCDA PVB SVO Size(in): Line Pressure(PSI): Installation:Horizontal: (y N Vertical: VU VD Other: New: Y N TTT Replaces Serial #: Check Valve#i Check Valve N2 Relief Valve PVB/SV_B_ _Scut Oil Vulva initial i (� Held atPSID ❑ Held at PSID Opened at Y [] Opened at #1 42 Test I Closed Tight Closed Tight --PSID PSID Closed Tight ❑ ❑ Leaked I ❑ Leaked Opened Fully [] Opened Fully ❑ Did Not Open ❑ Did Not Opm Leaked ❑ ❑ ❑ Check held at PSID ❑ Leaked ❑ CLEANED ❑ CLEANED ❑ CLEANED ❑ CLEANED CLEANED ❑ ❑ [] REPLACED: ❑ REPL ACW; ❑ gFPI:e[FTr ❑ RFp p� ❑ Disc ❑ Disc ❑ Disc ❑ Poppet I Float REPLACED ❑ ❑ ❑ Spring ❑ Spring ❑ Spring ❑ Air Inlet Spring ❑ Guide ❑ Guide ❑ Guide ❑ Check Disc ❑ Seat ❑ Seat [] Scat ❑ Check Spring < ❑ Hinge Pin ❑ Hinge Pm ❑ O-Ring(s) ❑ 0-Ring(s) ❑ Module ❑ Module ❑ Module ❑ Guide EJ NoTEs: Final Closed Tight NCtosed Tight Opened At Au Inlet PSID Shut Off- Testaives #1 #2 PSID �—\1 PSID SID CK Valve PSID I Closed Tight ❑ NOTE:Purveyor must be notified within 24 bra of any bacldlow,prevention assembly left In a failed(non-passine)condition. Tester's Name(please print): HAYDEN TANNER ID BAT License#:23903 Company Name: SPRINKLERS NORTHWEST Expiration Date:05/01/24 Company Phone: 208-818-8838 Email: Test Equipment Make&Model: MIDWEST 845 Serial#:03141084 Calibrated By: B.A.T.SUPPLY Calibration Date:09/24/22 1 certify the assembly was tested in acordance with U.S.C.test protocol and was in working condition, Test Results: Passed Frilled ❑ Apeiobly as left: Water Service Resturs6&Z_ BATTMA%&dwd&4,•— DRIC Si�oanee of Tracer Copy of Report to: Customer/Owner Water Purveyor F Licensed Tester Water Purveyor: ..10111111-- CustomerBusiness Name: Heather Johnson Date: 5/9/2024 11�; IIanaford Rd Assembly Service Address: Blanchard. ID 83804 Location of Assembly: L SIDE IN BED Type of Hazard Controlled: Z ie-� Assembly info-Make: Wilkins/375 ] Serial# B331476 PBA)RPDA DCVA DCDA PVB SVB Size(in):+ Line Pressure(PSI): _ Installation:Horizontal: O N Vertical: VU VD Other New: YU Replaces Serial #: Cbft k vain#1 Cbeek Valve#3 Ratlef Valve PVS/SVB Sbrt Off Valve Initial � ld at PSID9212 /Heid atPSID doped at ❑ Opened at #1 1{2 Test Closed Tight 0-c-losed Tight I PSID PSID Closed Tight ❑ Ucaked ❑ Leaked Opened Fully Opened Fully (� Did Not Open ❑ Did Noe Open Leaked ❑ ❑ �] Check held at PSID ❑ Leaked ❑ CLEANED ❑ CLEANED — ❑ CLEANED ❑ CLEANED CLE%NED ❑ ❑ REPLACED ❑ REPLACED: ❑ REPLAM: ❑ REPLACED: (� Disc ❑ Disc ❑ Diu ❑ Poppet/Float REPLACED ❑ ❑ Spring ❑ Spring ❑ Spring ❑ Air Inlet Spring ❑ Guide ❑ Guide ❑ Guide ❑ Check Disc Seat ❑ Saat ❑ Seat ❑ Check Spring ❑ Hinge Pin ❑ Hinge Pin ❑ O-Ring(s) ❑ 0-Ring(s) �] Module ❑ Module ❑ Module ❑ Guide a ❑ ❑ . ❑ ❑ Final yCloud Tight T C' (Osed Tight J/Maled At Air Inlet PSID Shut Off Va veal #t N2 Test PSID PSID PSID CK Valve PSID Closed Tight p` — NOTE:Purveyor must be notified within 24 furs of any backflow prevention assembly left in a failed(non-passing)condition. Tester's Name(please print): DAN ROSE ID BAT License#:23366 Company Name: SPRINKLERS NORTHWEST Expiration Date:4/20/2025 Company Phone: 208-818-8838 Email: Test Equipment Make&Model: MAKO MK5 Serial#:02AC22040141 Calibrated By: MAKO Calibration Dato:09/21/2023 t cemfy the assembly was tested in scordance with U.S.C.test protocol and was in work;j condition Tea Results: Passed Failed ❑ Assembly at L.eR: Watar Service RestorvdQ--_J1T T■p AttnchedG;.-- /_"In '7" swrur issuer- v,< Copv of Report to: Customer"G--T r ❑ Water Purveyor ❑ LunseJ restcr Water Purveyor: '�c ( ;�� Water � ,�II File Pun,evor: U I( (�-b n e gi u L Ujh I IT) [ No: Service Address of assembly ,�qS }"I U n c fp r 4 (.-f- Loc•alion of assenrb/r on prenrise n D U l'- Suppfv to: J F r I n KI tn Owner r►f assembl►•: U a L K gyp, ',, Owner address: 1 GlY1Q Cih' V I on <h ► �-f A ZIP q 3EU I Manufacturer: Model No: -7(Ui4 Size 7 7�9(� Stvle: RP D DC D DCDA D RPDA D PVB SVB D Orientation New Slrstenr Pressure Install ' r Reduced Pressure Principle Assembly at this location Y N �cu PSI Double Check 1'alve Assemblv Check I alve# 1 Cbeck 1'u/ve#? Relief Valve P1'B/SVB _j INITIAL Held at PSID Held at PSID Air inlet Opened at PSID opened at ';,I TEST Closed light D Closed light D Did not open O Opened Fully Leaked D Leaked D Did not open O Check valve� '/ Cleaned O Cleaned O Cleaned O held at Z REPAIRS Replaced O Replaced O Replaced O Leaked O Cleaned D Replaced D FINAL Closed tight Closed tight Opened at Air inlet TEST Leaked O Leaked O Did not open O Check I a/ve Comments: Inilial test bl': r.l i s N a J h Date: "I Certification/License# A T S3 Pass�j Fail O RepairedlCleaned by Date: Date: Final Test bv: Date: Certiftcation/License# Pass D Fail O Water.service restore ? Y N BAT Firm sample I N 3H s Haiiaf-ord- BACKFLOW PREVENTION ASSEMBLY TEST REPORT CUSTOMER NAME CI G SERVICE ADDRESS 3 1 f f,� r^ L Gt.T "O.! W, T P l 'L, LOCATION Of ASSEMBLY e ��- C) a tee, SUPPLY TYPE OF ASSEMBLY NEW INSTALL PSI MANUFACTURER Fv G> MODEL 7 f,1 .4- SERIAL 'T�y �U 512E PVB/SVB CHECK VALVE # 1 CHECK VALVE a Z RELIEF VALVE AIR INLET OPENED AT 3• Z PSID INITIAL TEST OPENED AT PSI[ HELD AT PSID HELD AT PSID OPENED FULLY a CLOSED TIGHT CLOSED TIGHT u DID NOT OPEN u LEAKED [ LEAKED ❑ DID NOT OPEN u CHECK VALVE HELD AT LEAKED u CLEAND ❑ CLEAND CLEAND c CLEAND a REPLACED n REPLACED o REPAIR/FINAL HELD AT PSID HELD AT PSID REPLACED REPLACED r. CLOSED TIGHT c CLOSED TIGHT u OPENED AT PSID AIR INLET OPENED AT, PSID LEAKED r LEAKED ❑ DID NOT OPEN ❑ CHECK VALVE HELD AT_ PASS FAIL r.Inil, GAUGE N a I �) MAKE AND MODEL , C W c ) ')` CALIBRATION UATE TESTER LICENSE DATE REPAIRED BY DATE FINALTESTBV r� LICENSE r �7� 2 DATE WATER PURVEYOR 4tr �. n Nash S►� Son RPM - -i Aruncir- 208.500.9747 Call or Text for an Estimate ov Water (` U hh File Purveyor: n t (� V I 1 ZJ No: Sfi Service Address of assembly 60 Location of assembly on premise R 1 Q hf of 1 l Y S 1 Supply to: n i ►c Owner of assembl).: FICA Yl i� fi l i l Owner address: City Lan1La l/P J QJa Alunufac•turer: f-`�<< Model No:. Size �,Sari«dl-�&_97a.-Z� Style: RP C DC-0, DCDA O RPD.4 C Pi'B C SI 'B C Orientation Neli, Sys7ent Pressure Reduced Pressure Principle.-ts embly Installatt�o�jO (it this location Y <A✓ PSI Double Check Valve Assembly CJtec•k Valve# I f7teck ValveTT Pi RI S11B# l r INITIAL Held at 2 ( PSID Held at Z , ZPSID Air inlet Opened tit P.SI/) opened at TEST Closed tight,-40 Closed tight �- Did not open C Opened Fully C Leaked C Leaked C Did not open C Check valve Cleaned C Cleaned C (leaned C held at REPAIRS Replaced C Replaced C Replaced C Leaked C Cleaned C Replaced C FINAL Closed tight Closed tight Opened at .4ir inlet TEST Leaked C Leaked C Did not open C Check Valve Comments: Initial test by: r l l S ,a J Date: S 23 Certification/License# 2 �J9 Paso Fail C Repaired/Cleaned by Date: Final Test by: Date: CertificationlLicense# Pass C Fail C Water service restore ? Y N Hal Fs=Plc I\\' -35q Hanefo rd BACKFLOW PREVENTION ASSEMBLY TEST REPORT CUSTOMER NAME mc SERVICE ADDRESS 75- n LOCATION OF ASSEMBLY SUPPLY1- TYPE OF ASSEMBLY NEW INSTALL PSI 5 5 MANUFACTURER �Q�< i MODEL � SERIAL y qLI '7 SIZE f �� PVB/SVB CHECK VAL RELIEF VALVE �.. ' PSID E# 1 CHECK VALVE#2 AIR INLET OPENED AT 16 HELDAT �• PSID HELDAT INITIAL TEST OPENED AT Psil OPENED FULLY CLOSED TIGHT d CLOSED TIGHT y DID NOT OPEN IEAKEO r LEAKED DID NOT OPEN t: CHECK VALVE HELD AT LEAKED CLEAND n CLEAND n CLEAND ❑ CLEAND REPLACED a REPLACED REPLACED ❑ REPLACED REPAIR/FINAL HELDAT PSID HELDAT PSID CLOSED TIGHT _ CLOSED TIGHT OPENED AT PSID AIR INLET OPENED AT PSID LEAKED ❑ LEAKED DID NOT OPEN a CHECK VALVE HELD AT PASS FAIL GAUGE p t ' , MAKE AND MODEL f CALIBRATION DAIS FESTER LICENSE DATE REPAIRED BY DATE FINAL TEST BY LICENSE T ' 6 DATE (r WATER PURVEYOR 5 CJ 1 Nash & Son RPM REALT."' I nnn 1C � CAVATION 208.500.9747 Call or Text for are Estimate 01, Water Punr.1 r: \1 1 � �� I � t U� � I � �,S Fi/e Service Address of assenrhlti• ✓1 -I o n o Location of assembly on premise SUPPIy to: in Ki (H Owner of assem Jbh•: fT y L Owner address: )1� � lana GI V City VI Uh�,�(�1� ZIP_ 1/unnJrrrnrrc°r: (/iif '�,c, IfodelNo: 7ZC714 size_L—Scria! 7yj1j3Z St1•le: RP O DC O DCD,4 O RPD.4 O PVB ;KSVB O Orientation New SI•stem Pressure Installs 'nr% Reduced Pressure Principle:4ssetnhl► at this location }' L �J PSI Double Check Valve Assembly Check Valve#1 r�Checke#2 Relic) I'rrlre PVB/SVB INITIAL Held at PS/1) Feld at PS1D Air inlet Opener!(it MID opened at 1 , TEST Closed tight O Closed tight O Dirt not open O Opened firlly Leaked O Leaked O Did not open O - - Check valve Cleaned O Cleaned O (7concd O held at I I REPAIRS Replaced O Replaced O Replacer!O Leaked O Cleaner! O Replaced O FINAL Closed tight Closed tight Opened at .4ir inlet TEST Leaked O Leaked O Uid not open O Cheek Valve Comments: Initial test by: ON I S M 4,I Date: CertificationlLicense# Pro slQ Fail O Repaired/Cleaned ky Date: Final Test by: Date: Certiftcation/License# Pass O Fail O Water service restore ? N BAT Form sample LW