Backflow Preventer Test and Inspection Report Instructions

Transcription

1 Backflow Preventer Test and Inspection Report Instructions June

2 Backflow Preventer Test and Inspection Report Form The Backflow Preventer Test and Inspection Report is used to record the annual test and inspection activities conducted by the qualified person. The Report requires information on the owner and facility that the device is located at, the qualified person carrying out the test, the test kit employed for the test and the specifics of device being tested as well as results of the test. June

3 Information for the Facility Facility Address: Indicate the address of facility that backflow preventer is located at. Occupant: Person/Company who currently occupies the facility/building. Contact/Contact Phone #: Specify the person who can be contacted by the City for backflow prevention program. Address of Owner/Postal Code: Indicate the owner s mailing address and postal code. PLEASE NOTE: Please fill out all applicable fields in the form and be as specific as possible. Otherwise, the form will be returned if deemed unacceptable. Contact information for the City of Markham June

4 Information for the Qualified Person Qualified Person Name and OWWA Cert#: Make sure to fill in both fields as they are vital to the form s acceptance since only those testers registered with the City are permitted to do backflow prevention works in the City. Please Note: If the qualified person is an apprentice, the master plumber or journeyman plumber who supervised the test must be co-printed here and co-sign the report as well. Test kit Maker/Model/Serial #: Specify the maker, model and serial number of the test kit employed for this test. Date of last calibration: Indicate the last date the test kit has been calibrated. Business Name/Address/Postal Code/Phone #: Provide that Qualified Person s company information in those fields. June

5 Information for the Backflow Preventer Device Make/Model/Serial #: Find those information indicated on the device and record them on the report correctly and written clearly. Installed on What System: Select the type of water system the device is installed on. Type of Isolation: Indicate which type of isolation the device is used for. Device Orientation: Indicate whether the device is installed horizontally or vertically. If neither of them, specify other type of orientation. Location of Device: Specify which area/which room the device is located. Building Permit #: Building Permit is required for new installations or replacements. Put the Building Permit # for the City s cross reference. June

6 Type of Test and Type of Device Type of Test: Indicate which type of test being conducted. Initial Test It is the first test for newly installed devices. The Building Permit # field must be filled in. Annual Test It is regular test for existing devices. Replaces Serial # It is the first test after the previous device has been replaced. The Building Permit # field must be filled in. Also, the serial # of previous device should be recorded. Type of Device: Specify which type of backflow preventer is being tested. June

7 Testing Information for RP/RPF Backflow Preventer 1. Differential Pressure Relief Valve: The relief valve shall open at a minimum 13.8 kpa (2 psi) pressure differential. 2. Check Valve 1: o Check Valve 1 shall close tight in direction of flow. o Holding a differential pressure for a minimum period of 2 min or until the gauge reading stabilizes. o The differential pressure across Check Valve 1 shall be at least 20.7 kpa (3 psi) higher than the opening pressure of relief valve for an RP Backflow Preventer. But, this doesn t require for an RPF Backflow Preventer. 3. Check Valve 2: o Check Valve 2 shall close tight in reverse direction of flow. o Holding a differential pressure for a minimum period of 2 min or until the gauge reading stabilizes. o Take the reading and record on the form. 4. Static Line Pressure: The static line pressure should be taken at the time of the test and recorded on the test report form. 5. Test Result: Indicate the test result either Passed or Failed. 6. Test Date: Indicate the date test being conducted. June

8 Testing Information for DCVA/DCVAF/SCVAF Backflow Preventer 1. Check Valve 1: o Check Valve 1 shall close tight in direction of flow. o Holding at least 6.9 kpa (1 psi) differential pressure for a DCVA/SCVAF Backflow Preventer. Or, holding at least 3.4 kpa (1/2 psi) differential pressure for a DCVAF Backflow Preventer. 2. Check Valve 2: o Check Valve 2 shall close tight in direction of flow. o Holding at least 6.9 kpa (1 psi) differential pressure for a DCVA Backflow Preventer. Or, holding at least 3.4 kpa (1/2 psi) differential pressure for a DCVAF Backflow Preventer. 3. Static Line Pressure: The static line pressure should be taken at the time of the test and recorded on the test report form. 4. Test Result: Indicate the test result either Passed or Failed. 5. Test Date: Indicate the date test being conducted. June

9 Testing Information for PVB/SRPVB Backflow Preventer 1. Air Inlet Valve: o The Air Inlet Valve begins to open when the pressure is at least 6.9 kpa (1psi) higher than atmosphere pressure. 2. Check Valve : o Check Valve shall close tight in direction of flow. o Holding at least 6.9 kpa (1 psi) differential pressure. 3. Static Line Pressure: The static line pressure should be taken at the time of the test and recorded on the test report form. 4. Test Result: Indicate the test result either Passed or Failed. 5. Test Date: Indicate the date test being conducted. June

10 Area for Repair If the device failed the test, the qualified person should carry out the repair and record the result in this area. June

11 Area for Re-test After the repair of device, the device has to be retested and the re-test results are recorded in this area. June

12 Signatures and Disclaimer: Remarks/Comments: Place for putting down any comments related to the test it may have. Please read the provision placed above and below the signature box before signing this test Report. Please be advised that both the qualified person and property owner/tenant have to sign off this report prior to its submission to the City of Markham. THIS FIELD IS FOR OFFICE USE ONLY June