21900 93RD PL W.PDFiiiiiiiiiiii
9089
21900 93RD PL W
STREET MEPECIALTIES CO.
Servite & Testing
12853 N. E. 83rd Street
Kirkland, WA 98033
DICK UNGER BACKFLOW DEVICE TEST REPORT PH: (206) 827-496d
RETURN NO LATER THAN -T
FILE NO
11 -0
NAME OF PREMISES
(" Dave Bitterman
�,LK7t6Lj_kUU#Itbb 21900-93rd Place W. Edmonds, WA 98020
LOCATION OF DEVICE N.E. corner of oroDertv. @ water meter. 8' back of curb. 6' S. tre,
DEVICE DCVA Manulaclutei Wilkins Model 550 Sue 1 if Se,.al No W71 063
LINE PRESSURE AT TIME OF TEST I PRESSURE DROP ACROSS FIRST CHECK VALVE
CHECK VALVE NO. I
CHECK VALVE NO. 2
DIFFERENTIAL PRESSURE RELIEF
VALVE
INITIAL
1. Leaked ......................
1. Leaked ......................
1. Opened at - lbs.
TEST
reduced pressure
1 2. Closed light ..................
2. Closed tight ..................
2. Did not open ..................
1:1
Cleaned ........................
El
Cleaned ........................
El
Cleaned ........................
0
Replaced:
Replaced:
Replaced:
Disc ........................
Disc ........................
Disc, upper .................
1:1
Spring ......................
Spring ......................
Disc, IlDwer ..................
El
R
Guide ......................
Guide ......................
El
Spring ......................
0
E
P
Pin retainer .................
El
Pin retainer .................
E]
Diaphragm. large
A
Hinge pin ...................
IJ
Hinge pin ...................
El
Upper ...................
0
1
R
Seat ........................
0
Seat ........................
0
Lower ...................
S
Diaphragm ..................
EJ
Diaphragm ..................
El
Diaphragm. small
Other. describe ..............
Other, describe ..............
El
Upper ...................
Lower...................
0
Spacer. lower ...............
Other. describe ..............
FINAL
Closed tight ....................
Closed tight ....................
El
Opened at - lbs.
TEST
reduced pressure
Remarks: INSTALLED PLUGS IN ALL T�ST COCKS.
-1 JUHN HLPORT TO
CITY OF EDMONDS
250 Fifth Street N.
Edmonds, WA 98020
d
THE ABOVE REPORT IS CERTIFIED TO BE TRUE
TESTED BY DICK UNGER Z��
Ht:PAIHE:D BY
FINAL TEST BY
CERTIFICATION NO. 3578 DATE 2-21-90
P",
Am )A-noN
for CARD NO . .................. ..
The City of lEdmomh SEDE SEWER -J,?ERMff EASEMENT No. .......................... ...........
OUTSIDE INSIDE 13 REPAIRS 13
L
OWNER ............. ..... fi�—..T— V.. P ................................................. CONTRACTOR /&A ..... . ............... PERMIT N
STREET
HOUSENo . ..... ... rj. ................................ AVENUE LOT No. . ................. *4 ............................. ..... ........... . . BLOCK No . .................... ...............................
5
NAME ADD ........... k)-Z�5T.GA!f ....... C ............. ..........................
*/?rl ..... ....... ....
17 ckl/
7460
clr't 1962
""0410
Date Approved;
BACKPILL WORK ORDER ISSUED .............. ............................. DEPOSIT, $ ...................... .................. ............
't . .........
SEWER WORK ORDER ISSUED - .............................................. ...... .......
... BY.�-9 ............................................
NOTICE,
-N*0"*w-'a*r-r af
The -information on the attached
Hed for u-se by the City Of
map(s) was c0MP'
Edmonds/ its Empl.oyees and Consultants.
Th,.e City of.'Edm.onds does . n ot. warrant the
acy of anything set forth on these
accur
m a p ('S-'). A n . y person or entity -requesting a
copy should conduct an independent
'e infbrm'ation shown*c)
inquiry regarding th imited to,
_tFe Map(s)', including, but not I
ion of any sewer stub shown. Suc
the lociat*
sewer stubs may or may- not exist and may
or may not exist at the location shown
Neit-heir the -ity of Edmonds nor its
i-ce.rs,sh-a-1-1 be 1--i-a-b].-e for thE
emp-1.0-yee-s O*r Off*
I n on this map(5), nor for
information give' d
any one representation provided base
upon . said map(s).