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HomeMy WebLinkAboutPLIRR2021-169897*e telEo+cim+ it+m ma.t he CrCnptfted f+r caAt as+c+nbtr tcs;nt A sicn<d aroi 4mM oripieal must iK suhmiu<+1 to tric nuhlic water N..AMF. OF PWS: P%VS ID#: �11� i, MAILING; ADDRESS: PWS CONTACT PERSON:- ADDRESSOFSERVICF: �� � w The backilow prevention assembly det•w ed beluw has been tested an aad is certified to be operating within acceptable par:nneters. 'I Yllb OF BACKFLOW PREW-N Q I Reduced Pre.ssme Principle (RPBA) 10 I Reduced, Double Check Valve (DCVA)4 Q 1 Double Cht c t ElPressure Vacuum Breaker (PVI3) ,❑ ( Spiii Resis " yi i Manufacturer. MainBypass: _ Model Nurnbrr Main:. 1( y, Bypass Serial Number: Maiu: $7bcff7 Bypass: — — Rcasun for test: I New I Existing❑ �_— j ReplPmQ aceent O I Is the assembly installed) in aecordancc with utanufactuior reeonnncndmio s the assembly installed on a non potable water supply (auxiliary)? ' TEST RESULT) Typ Reduced Pressure Principle Assembly (RPBA) A"vi PASS DCVA --- -- — Relief Valve Bypass FAIL ElI"Check 2`"Check'*' 11 Initial Test Held al, QO Pad i Held at � psid ff F% D"tc Wl Closed Tight I yq Closed Tight Tiaie: Jb � 5�� Leaked ❑ Leaked ❑ Repairs and Ivinin: Materials Used" Bypass: Test After Held at �a psid Held ❑t _� psid Renoir Closed Tight ❑ Closed Tight ❑ Dane: Time: ❑ I-o R Nu ©lxnad at.— I Held at —J psid Opened at � psid psid Closed Tight ❑ ; bid not open Q bid not Leaked ❑ Vid it fully open topcn ❑ �. (Yc. ❑1No Of at I IItetd al _ ight ❑ ' check: numeric Wading ttrpuiied for DCVA only Differential i c users: Potable: Ali Al�+hdklal cl- ? SN: bell) }'iJ` rJ1ri SVB at,__ psid (Held at Non -Potable: Q Daie tested for accuracy: /qI4 Z Cgropany Narne, T Liceased'rester Name - --�''N'1LIa/1„ i {PrinVi'ype): Cpsnpanyrjlidress: /'QytC/ `-Licensed Tester Name (Signature): Cbvany P;tUnc, b: 1 HPA'I' Licensc # 1-icense. Expiration Dater ifif The above is ccrtificd to be true at the time of testis( rt TPST RCCORI)S %WST BI; !iEl f pOR A ILEAST i'HREE YEARS [30 TAC §240A6(B)1 ^# USF ONLY x1ANUFACk ItLR'S REPLAt:ERIFNT PARTS CA N P'lYn TIOG�JES':'y'ciiJP. D�f' FINAL CHECK LIST DATE: IV 4 I2A PERMIT #: ADDRESS: /t�¢ _ FINAL WALK THROUGH TO EXPLAIN THE OPERATION OF THE SYSTEM 2 MAINTENANCE CHECK LIST: A. THE MANUFACTURER'S MANUAL FOR THE AUTOMATIC CONTROLLER B. A SEASONAL (SPRING, SUMMER, FALL, WINTER) WATERING SCHEDULE C. A LIST OF COMPONENTS 7HAT REQUIRE MA INTANANCE 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 IS HAS BEEN INSTALLED ACCORDING TO THE IRRIGATION PLAN AND IS PROPERLY ADSUSTED FOR THE EFFICIENT OF WATER AT T HIS TI ME 4. PERMANENT STICKER: COMPANY AND WARRANTY DATES 5. IRRIGATION PLAN TO OWNER l OWNER OR O r 'S RE��ESEN ,VIID-CITIES IRRIGATION, INS. REPRESENTATIVE . if. BiSi`i 5227 4