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2 combined BACKFLOW reports 01-09-20 13-11Backtlows Northwest, Inc. Ba411ows' Flaithwesi (425) 277-2888 BACKFLOW PREVENTION ASSEMBLY TEST REPORT WATERPURVEYOR Edmonds Public Works ACCOUNT# ASSEMBLY ID/FILE #IUTILITY DEVICE # Meter # NAME OF PREMISE Edmonds-WoodWay High School Commercial Residential SERVICE ADDRESS 7600 212th St SW Edmonds ZIP 98026 CONTACT PERSON PHONE LOCATION OF ASSEMBLY On hvdrant DOWNSTREAM PROCESS Hydrant Use DCVA RPBA X PVBA OTHER RPZ NEW INSTALL ❑ EXISTING X REPLACEMENT REMOVED ❑ OLD SER.# APPROVED ASSEMBLY? YES ® NO ❑ PROPER INSTALLATION? YES ❑ NO MAKE OF ASSEMBLY Wilkins MODEL 975XLTCU SERIAL NO. 4279163 SIZE 2° DCVA 1 RPBA DCVA 1 RPBA RPBA PVBA 1 SVBA INITIAL CHECK VALVE NO.1 CHECK VALVE NO.2 AIR INLET TEST OPENED AT 3.5 PSID CLOSED TIGHT X CLOSED TIGHT X1 OPENED AT PSID PASSED X #1 CHECK_ 7.2 PSID LEAKED LEAKED —1 DID NOT OPEN FAILED PSID PSID AIR GAP OK? X CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE PART CHECK VALVE NEW ❑ ❑ ❑ HELD AT PSID PARTS ❑ ❑ ❑ LEAKED F- ❑ ❑ AND ❑ ❑ ❑ ❑ CLEANED ❑ REPAIRS REPAIRED TEST AFTER CLOSED TIGHT ❑ CLOSED TIGHT RV EXERCISED ❑ AIR INLET PSID REPAIRS LEAKED ❑ LEAKED OPENED AT PSID PASSED L FAILED PSID PSID #1 CHECK PSID CHK VALVE PSID L AIR GAP INSPECTION: SUPPLY PIPE DIAMETER DETECTOR METER READING LEFT SERVICE AS FOUND Isolation valve: Open Closed REMARKS: SEPARATION PASS I FAIL SOV#1: Open Closed I I SOV#2: Open I I Closed Bypass Psi: Closed Tight n Leaked ❑J LINE PRESSURE PSI CONFINED SPACE? TESTERS SIGNATURE: CERT. NO. B7075 DATE 01-08-20 TESTERS NAME PRINTE I ata TESTERS PHONE # 425-277-2888 REPAIRED BY: LIC NO. DATE FINAL TEST BY: CERT. NO. DATE CALIBRATION DATE 09-05-19 GAUGE # 06160827 MODEL 845-5 SERVICE RESTORED YES �x NO I certify that this report is accurate, and I have used WAC 246-290-490 approved test methods and test equipment. Backtlows Northwest, Inc. Ba411ows' Flaithwesi (425) 277-2888 BACKFLOW PREVENTION ASSEMBLY TEST REPORT WATERPURVEYOR Edmonds Public Works ACCOUNT# ASSEMBLY ID/FILE #IUTILITY DEVICE # Meter # NAME OF PREMISE Edmonds-Woodway High School Commercial Residential SERVICE ADDRESS 7600 212th St SW Edmonds ZIP 98026 CONTACT PERSON PHONE LOCATION OF ASSEMBLY in irrigation box directly west of tennis court behind bleachers DOWNSTREAM PROCESS Irrigation DCVA X RPBA PVBA OTHER DC NEW INSTALL ❑ EXISTING X REPLACEMENT ❑ REMOVED. OLD SER.# APPROVED ASSEMBLY? YES ® NO ❑ PROPER INSTALLATION? YES X NO MAKE OF ASSEMBLY Wilkins MODEL 950XL SERIAL NO. 4747399 SIZE 1 DCVA 1 RPBA DCVA 1 RPBA RPBA PVBA 1 SVBA INITIAL CHECK VALVE NO.1 CHECK VALVE NO.2 AIR INLET TEST OPENED AT PSID CLOSED TIGHT X CLOSED TIGHT X1 OPENED AT PSID PASSED X #1 CHECK PSID LEAKED LEAKED —1 DID NOT OPEN FAILED 2.0 PSID 2.3 PSID AIR GAP OK? CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE PART CHECK VALVE NEW ❑ ❑ ❑ HELD AT PSID PARTS ❑ ❑ ❑ LEAKED F- ❑ ❑ AND ❑ ❑ ❑ ❑ CLEANED ❑ REPAIRS REPAIRED TEST AFTER CLOSED TIGHT ❑ CLOSED TIGHT RV EXERCISED ❑ AIR INLET PSID REPAIRS LEAKED ❑ LEAKED OPENED AT PSID PASSED L FAILED PSID PSID #1 CHECK PSID CHK VALVE PSID L AIR GAP INSPECTION: SUPPLY PIPE DIAMETER DETECTOR METER READING LEFT SERVICE AS FOUND Isolation valve: Open Closed REMARKS: SEPARATION PASS I FAIL SOV#1: Open Closed I I SOV#2: Open I I Closed Bypass Psi: Closed Tight n Leaked ❑ JLINE PRESSURE 75 PSI CONFINED SPACE? TESTERS SIGNATURE: CERT. NO. B7075 DATE 01-08-20 TESTERS NAME PRINTE I ata TESTERS PHONE # 425-277-2888 REPAIRED BY: LIC NO. DATE FINAL TEST BY: CERT. NO. DATE CALIBRATION DATE 09-05-19 GAUGE # 06160827 MODEL 845-5 SERVICE RESTORED YES X NO I certify that this report is accurate, and I have used WAC 246-290-490 approved test methods and test equipment.