Fillable Va Form 26-8731a - Water-Plumbing Systems Inspection Report (Manufactured Home) printable pdf download

Va Form 26-8731a - Water-Plumbing Systems Inspection Report (Manufactured Home)

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WATER-PLUMBING SYSTEMS INSPECTION REPORT

CASE NO.

(MANUFACTURED HOME)

NOTE TO INSPECTOR: All inspections must be completed following installation and set-up.

LOCATION OF MANUFACTURED HOME

SERIAL NO. OF MANUFACTURED HOME

NAME OF INSPECTOR

NAME AND ADDRESS OF FIRM

TELEPHONE NO. (Including Area Code)

ALL WATER PIPING HAS BEEN SUBJECTED TO A PRESSURE OF WATER OR AIR AT 100 PSI FOR 15

MINUTES WITHOUT LOSS OF PRESSURE?

1. CERTIFICATION OF WATER SYSTEM

YES

The drainage and vent systems will be tested by one of the methods described below for evidence or indication of leakage.

2A. AIR TEST - The fixture traps shall be filled with water and remaining openings securely

NO LEAKS DETECTED OR EXISTING

LEAKS REPAIRED?

plugged. The entire system shall be subjected to a 2 inch (manometer) water column air pressure

YES

test. If the system loses pressure, leaks may be located with smoke pumped into the system or with

soap suds spread on the exterior of the piping.

NOT APPLICABLE

2B. FLOOD LEVEL TEST - The manufactured home shall be in a level position, and the entire

NO LEAKS DETECTED OR EXISTING

LEAKS REPAIRED?

system shall be filled with water to the rim of the toilet bowl. (Tub and shower drains shall be

plugged.) After all trapped air has been released, the test shall be sustained for not less than 15

minutes without evidence of leaks. The waste piping above the level of the toilet bowl shall then be

YES

tested and show no evidence of leakage when the high fixtures are filled with water and emptied

NOT APPLICABLE

simultaneously to obtain the maximum possible flow in the drain piping.

3. FIXTURE TEST - The plumbing fixtures shall be subjected to a flow test by filling them with

FIXTURES FUNCTION SATISFACTORILY?

water and checking for leaks and retarded flow while they are being emptied. Nonmetallic shower

stalls shall be tested for leaks by filling the pan with water to the top of the dam for not less than 15

minutes. All water heaters shall be equipped with approved and listed fully automatic valves or a

single valve design to provide temperature and pressure relief. Full size drain lines shall be

provided and shall discharge by gravity without being trapped and shall not have the outlet threaded.

YES

FEDERAL STATUTES PROVIDE SEVERE PENALTIES FOR ANY FRAUD, INTENTIONAL MISREPRESENTATION OR CRIMINAL CONNIVANCE OR CONSPIRACY

PURPOSED TO INFLUENCE THE ISSUANCE OF ANY GUARANTY OR INSURANCE OR THE GRANTING OF ANY LOAN BY THE SECRETARY.

I certify that I have carefully inspected the above system in which I have no interest present or prospective and that I have reported herein all observed conditions.

DATE

SIGNATURE OF INSPECTOR

LICENSE NO.

VA FORM

SUPERSEDES VA FORM 26-8731a, SEP 1993,

26-8731a

JAN 2001

WHICH WILL NOT BE USED.