HomeMy WebLinkAbout1220 Truxtun Dr - Special Inspections/Backflow - 09/15/2005Oct 05 2005 4:53PM HP LRSERJET FAX p.3
Oct 05 05 01:42p ALAN FINDLEY 970-613-1309 p.l
-- ALAN & ADAM FINDLEY - A.S.S.E. CERTIFIED TESTERS --
BACKFLOW PREVENTION ASSEMBLY TEST & MAINTENANCE REPORT
Customer must retain a copy of this report for a minimum of three years
Water DisWct/Authmrity: _FT COLLINS/LOWMAND
1220 TRUXUN `5 K
FT COI.I.INS, CO $0526
Contractor/Manager PRO PLUMBING AND HEATING LLC
(Nailing Address: 124 S CLEVELAND AVE LOVE -LAND, CO 90537
Contact Person: TOM Title OWNER Ph 663-OM F461-0683
New' O
Use:
Existing❑ Replacement Fcr:
Domestic 0 Fire❑ Irrigation
Anembly'rype: Reduced Pressure 0 Uouble Check ❑ Pressure Vacuum Breaker
Other
Mfg,: WATTS Model No.: 800M4QT Size: 1 Serial No.: 561479
Date Installed: Last Inspection: N/A Line (treasure: 60 PSI
Location: SIDE OF HOUSE
Initial Test Result
Comments
RrrTest Results
T Dilferemud
T19ftnew DiMnoid
Check No l
Lwk
1. 6
TAk
W.DCM
Tires
6k
Check No 2
FLeekl
a(RP.DC)
Ttot
Relief Valve
Buffer
1i
Air Inlet
O"M)
M
NO BACK PRESSURE
Shut-eSvelveNo. 1
1ak ❑ Tight
NwioffvalveMe.2
Leak ❑ Tight ❑
ASSE TEST USED: 5010-1013.1 5010-1015.2 5010-1020.1 X 5010-
Repairs/Commetus: — —
Assembly Mechanical Test Passed ■ Failed ❑
Lf vm w" teat fails, 6c W4 w PowyodAudway most be notified immediately aad repair made as soon as possible.
Technician certifies this assembly has been tested in accordance whh ASSE 1Procedun+es
Test Technician: A. FINDLEY Cerdfication 0 ASSE # 9614 Expires:5/14/ 08
Signature: Lf Test Date: 9/15/05 Time: 10 AM
Phone: 970-667-8971 Test Gauge Model: WATTS TK99E Gauge Re -Cent Date: 5110106