602 7TH AVE N11111111111111
14739
602 7TH AVE N
C I T-Y 'PUIII.-IC WORJ'S DEPAR-TIMENT
OF E-DMOND-S
BACKFL-OW DEV I CL EST- REPORT
FILE
NAME OF PREMISES Y
SERVICE ADDRESS 630 Wa-
LOCATION OF DEVICE Zo, "�4t'm 5 IV, 14A I -A -e P- 0,4-
DEVICE: Co
R—li 11 u f a c t u--r-e r'
X
Model Size Serial No.
L.INE PRESSURE AT TIME OF BS.
PRESSURE DROP ACROSS FIRST CIN.C1, VALVL LBS.
VALVE NO. 1
.�CHECK
INITIAL I LE.AKED
TEST 2. CLOSED TIGHT
R
E
P
A
I
R
S
F I NAL
TEST
REMARKS:
CLEANED
m
REPLACED:
DISC -------------
I]
SPR I fir, -----------
0
(7,1J I DE ------------
0
PIN RETAINER -----
(11
Ill!','GE Pit,' * --------
n
SEAT -------------
(3
DIAPHRAGII --------
;. (3
OTHER, DESCRIBE --13
CLOSE-D TIGHT -----
CHECK VALVE 110.
2
DIFFERENTIAL,
RELIEF VALVE
1. LEAKED
CJ
1. OPENED AT
LBS.
2. CLOSED Ti.rI.IT. xI
CLEANED
W1
.REPLACED:
Disc ------------- 0
SlIp I ING � ----------- 0
M) I Of. - - o ----------- 13
Pill RETAIN'Ll' ------ G
H I NrE - P I N ---------- 0
SEAT ------------- 0
1) 1 A I'l I RA MI -------- 0
OTHER, DESCRIBE- --0
RI'Duc. (j—fj-P-ff-sT0c
DID --:OT OPEN
CLEMED L!
REPLACED:
D I SC. LIPP'FR ------------------------ E!
D I S C. L E R ---------------------- f.'.;
SPRPC, - ------------------------
DIAPHIZAtM-1, LARG C
U 111) ER -------------------------- (7
L0'--;LR -------------------------- L."
DJAPHRAGM., SMALL .
UPPER -------------------------
Lol.-!I�lz ----------------
S P A C F- ' R, L0e!(-R
OTHER., DESCRIBE
OPENED AT LBS.
0 CLOSED TIGHT ------ 0 REDUCIff-PIRF-9-SURf
'7'
THPABOVE RE -PORT IS * CERTIFIE =TuE
INITIAL TEST PERFORMED.BY F o7,-/dd,4 5- DATEC,/,, jf!K�—
,REPAIRED BY DATE
FINAL TEST PERFORMED BY OF DATE
A-r- 0
1 J.7-1
. . . . . . . . . . . . . . .
. . . . . . . ------------
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT
I L E EASEMENT No . ..........................................
,4EW CONSTRUCTION REPAIRS 0
115-o4ogo
owNER ........... Haly --- RQ�3�rY .... Qb34rqh ......................................... CONTRACTOR .................................................................................................. PERAUT No . ......................
ADDRESS ........ 6.CL2 .... 7th ... Ave.. .... N . .................................................... LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................ ................
NAMEOF ADDITION .........................................................................................................................................
0
Dye Tested On Sewer 1972
Approved:
DATE................................................ By ..................................................