HomeMy WebLinkAboutPLIRR2011-0475BACKFLOW PREVENTION'
ASSEMB TY OF.GRAPEVINLY TEST AND MAINTENANCE REPORTE
NAME OF PWS: GRAPEVINE
PWS I.D.# 2200013 ANNUAL TEST
IRRIGATION
OTHER
NAME OF BUSINESS WHERE DEVICE IS LOCATED:
ADDRESS OF SITE SERVICED:
PIi A- I
PLUMBING PERMIT IF APPLICABLE: #
711
TESTER LICENSE NUMBER: 1111 �1
61
DATE OF LAST TEST GAUGE CALIBRATION: 7 EXPIRES:
THE BACKFLOW PREVENTION ASSEMBLY DETAILED BELOW HAS BEEN TESTED AND MAINTAINED AS REQUIRED BY
TCEQ REGULATIONS AND IS
CERTIFIED TO BE OPERATING WITHIN ACCEPTABLE PARAMETERS,
TYPE OF ASSEMBLY
REDUCED PRESSURE PRINCIPLE PRESSURE VACUUM BREAKER
`DOUBLE CHECK
ATMOSPHERE VACUUM BREAKER
MANUFACTURER:
MODEL:
SIZE:
SERIAL NUMBER:
PHYSICAL LOCATION OF METER: ro
fl I REDUCED PRESSURE PRINCIPLE ASSEMBLY
ASSEMBLY
11T CHECK 2ND �
CHECK RELIEF V
Initial I Dc�p cIosedTigpt CloseclTight
- ,;2-,C) P i d
Test
Leaked Leaked
Materials
PRESSURE VACUUM BREAKER
AIR INLET
Open at
Test I DC -Closed Tight
Aft Closed Tight Opened atOpened --
at
aL� sid psid p,
_Id
CHECK VALVE
p1sid
The above is certified to be Prue.
TESTERS FIRM NAME- E
ADDRESS:
CITY/STATE/ZIP:
'7�
DATE:
PHONENUMBER:
PRINT NAME: SIGNATURE: --------- —
—ISPECTION A T (817) �4
DOUBLE CHECK VAL VE INSPECTION MUST BE CALLED
HOODOCUME-Mba"eN A S-1\TemP1XPqrpw1selTCEQ BACKFLOW TESTER REGISTRATJONA��
M- 4/05, I/D6'2/G10L 10-3010
MAY 16 2018
STENSON LANDSCAPE &
IRRIGATION, INC.
P.O. BOX 502
0
LAKE DALLAS, TX 75065
(940) 498-7440 • STENSONL.AND.COM
Statement of Compliance
Re. 2529 Springhill Dr, Grapevine, Tx 76051
This irrigation system has been installed in accordance with all applicable State and Local laws,
ordinances, rules, regulations and orders. I have tested the system and determined that it has
been installed according to the irrigation plan and is properly adjusted for the most efficient
application of water at this time.
w
pF TEAS
y:
CFNS�p \F,P�
BACK FLOW CITY
ASSOEMBLYY TEST AND MAINTENANCE R
NAME OF PWS: GRAPEVINE
PWS L ANNUAL TEST
D.# 2200013 IRRIGATION
NAME OF BUSINESS WHERE DEVICE IS LOCATETE D: OTHER ^`
ADDRESS OF SITE SERVICED: 5 I(\J!�4
PLUMBING PERMIT IF APPLICABLE # LL
TESTER LICENSE NUMBER: C �/�
DATE OF LAST TEST GAUCE C-AL — EXPIRES r�rr
lBP,A,TI CN: �
THE BACKFLOW PREVENTION ASSEMBLY DETAILED BELOW HAS BEEN TESTED AND MAINTAINED AS REQUIRED BY
TCEQ REGULATIONS AND IS CERTIFIED TO BE OPERATING WITHIN ACCEPTABLE PARAMETERS.
TYPE OF ASSEMBLY
REDUCED PRESSURE PRINCIPLE
PRESSURE VACUUM BREAKER
D UBLE CHECK
j� ;� ATMOSPHERE VACUUM BREAKER
MANUFACTURER: f��CLl e
f� � SIZE:
MODEL:_ /1 \ /� SERIAL NUMBER; C 1
PHYSICAL LOCATION OF METER: Z' L ( � r
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BREAKER
DOUBLE CHECK VALVE
ASSEMBLY AIR INLET CHECK VALVE
1" CHECK 2ND CHECK RELIEF VA VE
DC-ClosedTight Closed Tight Open at .` sic,Initial _RP�psid OP ne at !psid
Test L. D!d t n
ea e
Leaked Leaked psid �--
rrr
Repair Y
Materials
Used
Test DC-Closed Tight
After I Opened at Opened at
Repair _RP_ psid Closed Tight
psid _psid --psid
�/ The above is certified to be true.
TESTERS FIRM NAME: `.' e,t' ?T{ror
ADDRESS:414"—
—�LQ_ _CITY/STATE/ZIP: blFsy
DATE: �— L r r} PHONE NUMBER:
//
PRINT NAME: t 1bVN%, )I&-Y.
SIGNATURE:
DOUBLE CHECK vVALVE QINSPECTION TMUST BE CALLED 41 SPECTION AT(817) 410-3010
+++]1DDNBV.1105.".2110
CITY OF GlUPEVINE \-�P. tt4 a
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE
REPORT
NA9[E OF Ptt'S: GRAPEVINE
ANN-UAL.TEST
PWS I.D_4 2200013 IRRIGATION
OTHER
NA9[E OF BUSLVESS\VHERE DEt7CE IS LOCATED:_ ��S't��,
O ADDRESS OF SITE SERVICED: Z.S 7 'j,
IF
TESTER LICENSEINU7B,ER; IC L� LE:
DATE OF LAST TEST GAUGE CALIBRATION: EXPIRES: G
- CG
TIIB BACtCF[AVV"PR'ElT.1"CIDN.1S5E1fB1.1'DM',Vt.ED BElAR'[L1S BEf\'f1;SCT;b A.YD 9L11\T'AINED AQ RF.gtM.,.D M,
.r" 'R£Gi1.:i'CIQ\S.L1p ISCCRTTFRiD TO IMRPERA'"NG14TTIIIN,1CCA"f,VBLE PA.RA1p;Tr
TYPE OF ASSENIBLV
UCED PRESSURE PRINCIPLE _PRESSURE VACUUM BREAKER
UBLE CHECK _ATAIOSPHERE V
7 VACUUM. BREAKER
MANUFACTURER: ��� � SIDE:
hIODEL: X / SERIAL NUh[BER: 1/ Es
PHYSICAL LOCATION OF?vfETER:
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUtrt BREAKER
DOUBLE CHECI(VALVE CHECK
ASSEMI;LY AIR INLET
VALVE
OT CHECK 2"P CHECK RELIEF VALV
)
DC-C[ sed'Cght Clo>kd Tight
InLtinl RP�� paid � 1"' 'd
Test U Id 1 o I�
Lca{ucd Lca[sd aid
SYrpois
\Iaecrlats
i�red
Test DC-Cke d Tt_hr
bExre�cd nt ut
Rrym RP_ pid CI+MCd T(;ht i?fit' Fsid
—Paid -_—!r^�d tS
JlilThe above is vet' Peal to Ix,trur.
TESTERS FIRRn4 NAhIE: l-1«�"� ��j�,✓�'T�T/
ADDRESS:— /% 7/ �'�I��l�/N CI'IY/STATEIZIP:
DATE: - 2 3" l j PHONE NUA4IiER: �'l �Gt�
PRINTNAME: �iJ V[S �yr �1 SIGNATURE:
D(1U131,ECHECK 1�4LtE'I,hSPECTIO.YAWSTf3EG1LLEDFORh\ ECl7U,ti tT(6'17),flO-3010
?._Fc'YR.\IgN,VCi;F].Gll'RP.I,f?FItAF[^N.J,w
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