HomeMy WebLinkAboutPLIRR2022-2175
Breakthrough Irrigation
682-556-1965
8-26-2022
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.
Nick Campbell
Breakthrough Irrigation
LI 8002
1617 Silverside
Grapevine, Texas
Texas Commission on Environmental Quality
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping'xpurposes:
NAME OF PWS: AJ /- - - -
PWS ID#:Oa 33 �.
PWS MAILING ADDRESS: i 5W.4DV Aev
{ PWS CONTACT PERSON: GWyGLduJ e4c+")1-�'�
ADDRESS OF SERVICE: ,;/L t/%(L51 o S
The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations
and is certified to be operating within acceptable parameters.
TYPE OF BACKFLOW PREVENTION ASSEMBLY (BPA):
'(❑ Reduced Pressure Principle (RPBA) ❑ Reduced Pressure Principle -Detector (RPBA-D) Type II ❑';
Double Check Valve (DCVA) ❑ Double Check -Detector (DCVA-D) Type H ❑+
`';❑ Pressure Vacuum Breaker (PVB) ❑ Spill -Resistant Pressure Vacuum Breaker (SVB)
Manufacturer: Main: I) t 11 L.,A& l &/5 Bypass: Size: Main: L3✓�1 Bypass:
Model Number: ( Main: o Bypass' BPA Location: 910#r- d/- pgluf, • , e&AS
j Serial Number: Main:019�0 Bypass: BPA Serves: OWN SPP_IA1K-i.AA_
Reason for test: New /E:r ( Existing ❑ Replacement ❑' Old Model/Serial #; -
Is the assembly installed in accordance with manufacturer recommendations and/or local codes? -R-Yes ❑ No
Is the assembly installed on a non -potable water supply (auxiliary)? I ❑ Yes I -Q-No
TEST RESULT Type lI
Reduced Pressure Principle Assembly (RPBA) Assembly 1 PVB & SVB
PASS.
FAIL ❑
Initial Test
Date:
Time:
Repairs and
Materials
Used**
Test After
Repair
Date:
Time:
DCVA
Relief Valve
Bypass Check Air Inlet
Check Valve
I" Check
2"d Check***
Held at psid
Held at psid
Opened at —
Held at psid Opened at, psid
Held at
Closed Tight Z'
Closed Tight 43
psid
Closed Tight ❑ Did not open ❑
psid
'❑
Leaked Cl;
Did not
Did it full open
Leaked ❑ y P
Leaked ElLeaked
open C3
(Yes ❑ /No ❑)
Main:
Bypass:
Held at psid Held at `psid Opened at
Closed Tight ❑ Closed Tight '❑ psid
`* 211`l check: numeric reading requi
Differential pressure gauge used: APOLVO_
Make/Model: 14{O,'loo
Remarks:
Held at psid Opened at psid Held at
Closed psid
Tight ❑'
I for DCVA ogly
Potable: Zf I Non -Potable:
I Date tested for accuracy
Company Name: ggtTt yf u Licensed Tester Name /,_
i i" .�i��Yl � (Print/Type) 4/Gl/V4j-5 iiLL
Company Address. Licensed Tester Name (Signature):
Company Phone #: _ _ BPAT License #
b a
V-S' P%6 S License Expiration Date:
The above is certified to be true at the time of testing.
* TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS [30 TAC §290.46(B)l
** USE ONLY MANUFACTURER'S REPLACEMENT PARTS
TCEQ-20700 (Revision 04-04-2019) Page 1 of 1