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HomeMy WebLinkAboutBackflow Prevention Assembly Test Report - Inspection - 4/23/2020 i CINTAS FIRE PROTECTION CINTA60 710 NARRAGANSETT PARK D READY FOR THE W IIAY"1 AWT CKET, RI02861 USA 02861 B c flo r Prevention Assembly Test Report Customer: NA KOHL'S .�..N._.n.......... _:_n:.t:=...._..,fi...._.,...:._.n.:.:v....v.x..-.r.x.v..:.:.. :..:..._v:.-. ._._. ,...,.....::r N............._.:_................._.......v....................v. ......... ...... --...N._.................._..._.... ... ._...............-.... Property Name: NA KOHL'S k........_..w.w_ .v..._.._... ...r.mm.......�_..�.N..m,.._.N�..N._v._..... ... ...._ _M_..__.........w......v..N.........vNnr.x.......�......vN_.�...:H,... ..:..v.r_. ...v..r_.......�.. ...n....x.......... w.._.. .r.,Yv...._._................. _................r.._.. .....ry w.�._.....,.. 'Address of Property: WINTHROP AVE FORTH AND OVER, CIA 018454289 _._.. ._. r...r.,,.... ---- .........N.MN.... m.......Wv..�.v.. �.r....n �.........0 ................._. ........w_r._..,..w.._,......._.��..., .._......._..._-... v�n..nM..v......n..._.......n_.,.....n �.. v N........_nv,_....................�A_v....w._t...:��.w.....x..v�..A.xx..x�.rx......:�..{.:r::..::.x..., .�.._:,....,x=.n:N_ . _ -..,.. � �.r� -- - - - -- - ............. '.: o b1 ':'Che Assembi Type of DC: D Double Check Assembly Location of Assembly: Rear warehouse _......_................_.._._...-.�.ryv.V.._..'........-........v......_..._n_v..__.._.. ... _........... v...._................. .._.._..._........ .. N .........v.._............ .....v.n..... . ...... _.. . j lfr.: Aromas Model# 200 SN: 1 21640 Size: " .......................r-.,......._.._�.w_,n,,......,,- -.,...........,.....n.... ....._......... ..... ... ........_.... ......., ..............._.., ....,..._. .._._.._n..,....n..v.. . Type of Protection: Containment Type ofService: Firelin v._v.....r.,._n..v...,..-..,....,,v_...__..,._......................__..rt.......n..... ._.._,.:........_n..............-..._.................................-........... r...............n. .._x_...n..n.. .... ..................................... Assembly orientation: Horizontal state of bacl flo r before test* Incoming Line Pressure psi: 140 V............. v_ ..v_.._..n...__......_n............_... _.v._........._ n.n... n...... .......t._.. ... .. . _. Check Valve ##1 Check Valve ## � shut Off ##1 shut Off _... _,. ...- tv_. _4_....._..._..... _.w.x.... ......._ ...._.. ....n. .... ... ... ......_...._.._................... ,...__..x n..._ .1nIti :Test.'. sad ' tat Closed ' at I ed lO ed T t ........... ..:.....:.....:........,�..r....,:.,:.....,._...:......_:...:,.v...n..:..::......_.... ............__ ... ,........ .. .-,v...__.-... . r .. ... ..._ . . .. ... .._._n, v...Y... .v . . ... _ . ........ ,.._..v_.. ....r .......... alb . :. C .r ail .I .:.':.: None :. ,ee,ed .�r:..:..:.::�:_ry-: xr.m:._:.M:.. ...n.._.vm.....L......_.w.._.ryr.._._k.�. v....n v..............v..... _......._....... .__........ ............ _....._..._....._ ........ .v.. .. ._.... .. ...... . .... ..... Check Valve #1 i check Valve #2 shut Off ##1 Shut off # eTe stN/A at psid N/A at psid N/A x.v.. ...x.¢....s%n.x,...f.n....x:...:.:..A.:::.,.:..:.-:,:.vf-::,.Yv_Y.:..:...._x...._:_.._._._v.._... .....n.H..,.....�n.............. ............. .......... ._N...n. ... ................M............. nn .........n....._._.........._......n.v........ ..v......,..ry..r...._..._........._..,..........-................n.-..... ............. f Test Completed: State of ba l flow after tests. On Test Results. Pass 10/1 /2 20 ....k_:;...f.r..:...:r-..r...--.....,.-._„.„-....��.....v..-.-..._......-...:_...�-._.�,..-.,.vv.........:-'i..-.�......�................ ........ ........................... .........._,....-.. -.. .. . .... . _...< ............ Comments: None :...r...-r:.x.,.:..„....:._:::...._... ,r,n '... ....................... ,...................r.,...__v.,_......,.vt.F,v,....r.M.,,.,._..... ................._v.._...._.._..........., ..............., ..,...—......_.._._., __.._.._............................ ... , r, .... .._..._....._,v,..... .................... Test for: L1 New install L7 Replacement-OLD �� � � Existing Device _.._......-....n.N.�n_...,_ �.....r:r.:.v......._.n_w.vN.........k...-....._..N....-._................ Y_ _.�. _ .. _....- - N- - -.-._.._... _...... v-'" -.._..'- -....._v_...__.._._._.._._._..._._..-'-'---...._._._.._._.... -.........._._.._.._....-'-'.---'-'--. �_..... r,....mM..r., t..._n., ._........_......... _.. ' ug 3e t:.Kid.: 1=rF GageIt Model: T - H: 174216 ?Cali . Date: 4-2 -2 2 Plhave completed the above test and hereby certify this Backflow Prevention Assembly performed satisfactorily and j meets Federal, State and local codes and regulations as required. ......_...--.........................ry......,.,_....v........__.v..._............_._.�.,w.......n................. ....1-...... Y ... .. ._....n...... ..._.............. ........ ........... ............ Certified Te ni ia.n:-....J. ::i N N F, .. .1 -. :0032 81s �µn...,.......n.......v...............:.:..n:.;::..:::N:x::Nnn:...v:...:t..:.v.:.n...,.,..:......:_.;.......: Customer: Xohl's/.Darwin v.................n r... ....n_..,. ._....._.....v._v....................................... . . x i f ...............r.._:......V-...-.__.-�..._...._......__.....v... ._._......__..�� .. __.._._...... .................._.._....................._ ........ _._._.._....._.._........... ._......__ .........__...__............_.._._............._......_.. .. _..._........._... ..._..__..._....... _..._...._..... ..._....._......_..._.._...._J BACK FLOW page I of Powered by ASURiO Znspection Systems, Copyright 2017. AH Rights Reserved ASUM0 P CINTAS FIRE PROTECTION CINTA60 710 NARRA ANS TT PARK DR READY FOR THE WORKDAYM PAWTUCKET, RI 02861 USA 02861 Ba kflow Prevention Assembly Test Report Customer: NA KOHL' 535 ..................... _...............................-.N................ ..........__...... ....._.................._......n............. v..........,.M.ry....n........ ... .._..n.................n.._....... Property liar = NA KOHL'S 55 j ..�...:.._.x....A :..........xH..-...m,.N_ N.....tn_..:..n,,,�..�_. :::.:::,:.._.:... _. ....,n......_v.N......V.......... .......... r.._...N._... .............._......_._........_............ x....... ...v n._.._.�_.. _..�..,.-.. ...... ......N...n�..H_tt...................::.. ................._ Address of Property: 350 WINTHROP AVEFORTH AND OVER, MA018454289 t 'Reduced.-Pressure Assembly :. Type of RP: RP Reduced Pressure Assembly Location f Assembly: Rear stock roam .-......v.r....-.w..._.n........_..........._.._..n.r.._._..v,....._w.n......._................._.v.....n..... ..._........Y.:..............�.r_...:................n......_M................. . .._. ....... ............ .._.... ...................._......._......... ... .................................."I",..... v. w, ......_. ._ ..__._._-v...... fr.; Watts ode! 00 T sN: 71176 Size: 1 1 " s 3 ............... Type of Protection: Containment Type of service: Irrigation.V v�,M„w�n..........:...n_R._.__..........n.v�.._.v,._._..,.....N._.._r�� ....v...._......._.......,.,.._..�ry..._v_....n..........,_n.y............_.................................... ..............._.............._....._.,...............�.......v.v.,...,.N,v., _. ... ......... ............_...vv. N,v.,..., ........._...._......_...,,..N.........v Assembly Orientation: Horizontal state of backflow before test: On Incoming Line Pressure psi: 65 CheckValve # . CheckValve # Relief Valve Buffer :.._ .,,......::.............-_:__. :_::.:_...:..:...::..:..,.,. . ...,r. ...._...w.. ....... ........_......x.._.._.n...{._........ . -... , r. ..,n...... N..................._.._..._...,....x......... . ..,.....V. _.... _............_ .. Closed �i xv..t....a...t...p..sid dosed�i ...a.tp.._s..� ...... Opened at psid .� .......... ...... .... ....... .. ........ . .. . ......... .._.......ry_ . nila Test .. .. . . .. . . . . .. _.�.�..,.....�.v.v..vxnv. .. x ... ..v...........�.„�.....,.....N. ...._................._..._.v ......_................_........N.w.__......._...__........._.........._.�N.w_..._..,n........ .. ..N...... .........r.�.__.........._._.._. Shut Off ##1 Shut off # V..........__...... --.................................. ...., Closed lose Yd. .Tight . . Y.. Closed Tight ....M...._.n...... ........ ._... !.Describe.pa.tt ..' 7'. . '' par .if::..: bone f :.'nee ..................' N...v.n......_....... ..,................ ..._.. Check valve ##1 Check Valve #2 Relief Valve Buffer t . x A n y__._...............N_........ ........__...__................._ -...............-....H............................... ..N,r x.......... ,�..._.._..... �....._..............,... RTt' N/A at psid A at psid - #Error 7 .. ... .. .... _ ....... .. .. .. .......f. ..:. slut off #1 Shut Off # I .... .. .. -.,,........_„ ..�..._... , < ''. ..............�.....tom....._.._ � _.... ....�................r.. r. ..-..� ,-••.__.�..._.... ..... ..... ._ ...... ............. ..._..... ._. ..-... � �. .........�.. .......�...... ... _. ..� ...�.._.... Test Completed: to o ba l f1ow after test: n "Vest Results: Pass 11 0 eta - ._.... . .............. ..... ._.......... ..... N N. ... ........ ... ..._. Comments: None ...................v._..._..._....:..v...ry.-..::. ....v::.,...w. tv.:-. ..n........... _...n.......... . ......,.. ......._.. .-..,.... . ........:.... ... .v.... .,v__..,n....... ..._...._.n...._.n....h._........................_.... N.............................. ..._ .. Hn.v....M........_........._..v......_......_. ............... ..n. Test for: Cl New install 11 Replacement-OLD # Existing Device __..._._..._.n_._...w.,r....n.............wx.....N.r.._.._..r.._.v_n_V.w..__.._....r...._........_...._....v..... ..._... ._._..n... r.... N ..�. r. ....t..... v_N..v............ n. -....... _... . �....t. _. N..... . Ga u g :Tt. ffr: Gage It ;Model: TIC--� S : 41 aiib� Datef - - I have completed the above test and hereby certify this Backflow Prevention Assembly performed satisfactorily and meets Federal, State and local codes and regulations as required. ........+.........._.....:...----- --....:._..__.......__._...................k.............n.........................._.......:.............._.. _._.............._..._...._......_ _. - - - -.. _.............. _-.:.. _....._ _.... rtiry._. ... .................:........ ......._.. efi .d.T tc * '. If ENN o.oa: I ( Customer: Kohl's/-Darwin :.. .... ............. ......... ............. ............................. r f 3 BACK FLOW Page 2 of Powered y ASURiO Znspectlon Systems, Copyright 2017. All Rights Reserved ASURi C NTAS FIRE PROTECTION 10 NARRAGANSETT PARK DR READY FOR THE WORKDAY10 PAWTUCKET, RX 02861 USA 1 Ba kflow Prevention Assembly Test Report clmks NOW 1161 rusor: NA KOHL'S 535 Property Name: !A KOHL'S T.��w .��..:.��... .. ...,.m. :. MN ._m._._:_:.... ay....n.:n:....,:.:....A....n.._..:..N...-..y.. ....w.:.:..::........_r:.:.:.... ..,:...:.-..........,�..:.:v..._._...--........ -...n............N..... ...rr-......-_.µ...M_N.......v.....V..n.....- w.. ..x........- --. . �...._v .....................__..-.Nv..........w... Address of Property: 0 WINTHROP AVE NORTH A D Z E , A 1 -- ............ . .._... v....... . .........n. . _........-._... dl::Prr. �nnl :: . Type o P; Reduced Pressure Assembly Location of Assembly: Rear toy room � r....-........n.x.x........._........N................ n..... ..._-. ..... -.......,v_. ..n- ..... ..... ......... . .. . .. . ....-..... .......... .."" -...... ............,.... "'....-. [ fr.: Watts Model: oo i T N: I7 Size: " x.w...w....v... .ry......._.....�.........�..�.-...t...........N.v..........��__..t...��...._.. .. .... .n..._rr,...._.._.... ...............r.._n.-. .....-..................., x.. __._... ...v..._.. .... ...v..._.....................- . . ...-......_-.... Type of Protection: Containment Type of service: Domestic ....--......M.,_x....-._..�.................�......w..-'.---------------------"-'.'- -........ N.._....... _........, n.. ....... .... ...... . ................. - v ........-........_...._............ Assembly orientation: Horizontal State of ba flow before test: n Incoming Line Pressure psi: 65 x... . Check'Valve #1 Check Valve # Relief halve Buffer . ....:.... . Closed Tight at psi i ps ,0 op :Initial Test 3 ' Shut off #1 shut off# __._.._......n....--.._............... _...................._...._.-...x.__..--v.. '-...._.....--....-._....v......-w............_-...-.__.-......... _. x ....N......... Closed Tight Closed Tight Describert .. .r a1 ..:.:':: None .w=M�.,.:�.�,�..Awn�Mn..ry�.-w.�,N:,:�.A::._....:...-.,....-..:._:�..::-:.:_...:-_.:.:..::x,.V.::.:..:........ n..-.. ._._.-.�-...................... ..-.: -.......x.....:-....,.......,.-........._.......................... ._........-.....-..-.-_..-......._ .-.....-.....-......-.....--.:.-...-.........x-..........n......,.........n...{.................._....., ... . ...n.._n x., ........_n Check Valve re #1 Check Valve # Relief Valve Buffer ._-............... .....-................ -.........-.-........ ............,..n.. ............... .. .. ... ... ... ....... ...r.. r. .. .,.....-......... -,..n......... ...n....N..................�.....--.....ry..n..... :lTt A at psid NA at psid -- #Error .........�...�._..n.r. ... . r... ...... . .................... ....... . -..-. ._..- . . . n : .... .. ... Shut off # �. shut off f .:. frrA {+fA .. # ! i Test Completed: 0 i o o Mate of backflow after test: n Test Results: Pass -:. .....Nv_.... ...-.n.-r..vN..rv:.n_v.....-...x.._:..:.............. ...__......................._......................-.v._.................rn-...._.-......-......-.......--........v...... . ...._......w. .....Y..... ....... , ...... .......... ... .... . .......-.. ..f..-.................. .......... Comments: None -:...:..:_,.�..:..:::n::�: .... -.-,. :w: ..�::.�::_.::::............:..::..:..n.:r.N.w._....._....._........::..r.......x...,..._.n....._,_..,.:,... ...x'.:_._...... .....r...:.:w.,._.......................n H......ry.... . ... n.-..................... ..................... ..........._.......�...-.........-......... .....,........_....-n....... Test for: New install ❑ placement- OLD C Existing Device .....................^__�V�.t..�..�.»-.:».-.��-........-�......,. ............. ...............,.............-v.....r�-................�.�........_....................�..._....�...._.._...-....��-. ��..,..-..».,...,.-...��,.....��-�.....�....�..._.3 : o ..:Test-Kilt: '. ... :'... ....' :.... '. . "'.'...'.'.... '...'.:... ... .. .. ..... 9 t fr: Gage t Model: TIC- ! : 174216 �Ca ib. Date: 4- - O o have completed the above test and hereby certify this a flo r Prevention Assembly performed satisfactorily and meets Federal, State and local codes and regulations as required. --' .._.-... '-'--..-._.._.:.._.-......-.-_...,-_.-._...._-.:_.-...:.._..---.... .'--.........__.........._..........................................................-"-' . -.. ._ .. ......_ ...........-.. .... .-............................-..... ..._........... ................. ........ .. ............ . .. ....:...:........................ .... Q. fied.::T . i i .n:.::.-..,] ::� III. M 1...00F .W 1 �.: st -:-'-' oh1' : ar i :..:.:. } BACK FLOW Page 3 of Powered by ASURiO Inspection Systems,Copyright 2017.r All Rights Reserved A URi