HomeMy WebLinkAboutPLIRR2021-0996Ib\Ll\P 4V 11 Tt\flr is*tnJ:*A.+aialtv4t u:ot ru tia nin a"J •,+"J�:e�.t: +�i,i viv
,the :omelcinf f.a ca:h n..end-h craved. A %iennt and daicd „ngmnl :nu4 he whmilicd pl tls �uhlic wa�tr gipphct tt�r rtt
ME Oh
ADDRESS OF SERVICE a ���_._�;rze� 7(p�L
the baekiluil preccru on.nscurb y dvlailed rclun fiat been tested anti maintained as required by comoussion regulations
and is ceniGttl to be a cratine within acceptablep:uamctas.
-~IYPI; OF 11ACK11,01iV PHENNNN ION ASSEMBLY iBI'A):
TF I Reduced Pressure Principle iR11BA) ❑ Reduced Pressure Print'iptc-De etor(RPHA-D) Tyln. it ❑
Rouble Check Valve (DCVA) (❑ ,Double Check-Detecior (DCVA-D) Type IT ❑
❑ Pressure Vacuum Breaker (PVH) i [j ( Spill -Resistant Pressure Vacuum Breaker (SVB) —�
Manut'acutrer Main:
Model Number: N1atn:
SeriaFIN untbcr.....
--
N-lain:
Reason for test: i Existing ❑ New g Rt , pl ttemcnt ❑ Old Model/Serial #
1s the assembly installed in accordance with manufacturer recommendations mdlor local codes! Yes ❑ No
Is the assembly installed on a non -potable water supply (auxiliary)! ❑ Yes ( ANa I
TEST RESULT
(Reduced Pressure Principle Assembly (RPBA)
PASS L DCVA
- -- Relief Valve
FAIL ❑ 11 Check r' Check***
Initial Test Held at Lj p5id Held at psud Opened at —
Daie:lp/lr Closed Tight (� Closed Tight psid
Time; Did not
Izaked ❑ Leaked ❑ ❑
q; 5'�.a.� npcn
Repairs and ;Main:
Materials ®p
Used** Low
Type 11
PVB & SVB
Bypass Check e Air Inlet e Check Valve
eld au _ psid Openeit au _ psid Held at
loud Tight ❑ Did not open ❑ Psid
eaked ❑ Did it fully open Leaked ❑
(Yes ❑ [No (1)
Test After Held at _ psid Hetd at _ psid Opened at - Held at
Re air Closed Tight ❑ Closed Tight ❑ psid Closed
Date: right
Time:
_ *' 2"' check: numeric reading required for DCVA only
Differential pressure gouge used: I Potable: � y
N-lakersltdcl-1 w;afu��'rsr�7sy5-,� i SN: tl
psid (Opened at ____ psid Held at _
psid
F*
{ Rue..... Nun-Noutblr. ❑
tested for accuracy: I .ti/'0f
Zko
Company ;Name:
Company Address:
Corupany Phone Or:
�} � � � Licensedype): Name (Printtfypc): —
it"rli2�'1t Licensed't'esterName(Signature):
Z- BPAT i icense #
�v��G'`�
�7��� License rxpirntiun Date:
The above is certified to be true at the time of test'"
TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS 130 TAC 4'290A6(B))
" USE ONLY MANUFACTURER'S REPLACEMENT PARTS
I on-1
S?_4j5S 3N ?fiN CT O � ` O�,
FINAL CHECK LIST
DATE: r� y/
PERMIT#: I 1 V ADDRESS: �In 1) J rA ea z,,5a Off.+
_. F!NAL WALK THROUGH TO EXPLAIN THE OPERATION OF THE SYSTEM
2. MAINTENANCE CHECK LIST:
A. THE MANUFACT URER'S MANUAL FOR THE AUTOMATIC CONTROLLER
B. A SEASONAL (SPRING, SUMMER, FALL, WINTER) WATERING SCHEDULE
C. A LIST OF COMPONENTS THAT REQUIRE MAINTANANCE AND RECOMMENDED
FREQUENCY FOR SERVICE.
#1 CHECK AND CLEAN NOZZLE'S MONTHLY FOR CORRECT COVERAGE
=2 TEST RAIN/FREEZE SENSOR EVERY MONTH
=3 SERVICE AND CLEAN Y STRAINER YEARLY
3. THIS IRRIGATION SYSTEM HAS BEEN INSTALLED IN ACCORDANCE WITH ALL APPLICABLE
STATE AND LOCAL LAWS, ORDINANCES, RULES, REGULATIONS OR ORDERS, ! HAVE
TESTED THE SYSTEM AND DETERMINED THAT 1S HAS BEEN INSTALLED ACCORDING TO
HE IRRIGATION PLAN AND IS PROPERLY ADiUSTED FOR THE EFFICIENT OF WATER AT
THIS TIME
4. PERMANENT STICKER: COMPANY AND WARRANTY DATES
a` IRRIGATION PLAN TO OrNER
6
OWNER OR OWNER'S REPRESENTATIVE
MID -CITIES IRRIGATION, Mt REPRESENTATIVE