HomeMy WebLinkAboutPLIRR2015-1958CITY OF GRAPEVINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: GRAPEVINE ANNUAL TEST
IRRIGATION"
PWS I.D.# 2200013 OTHER
NAME OF BUSINESS WHERE DEVICE IS LOCATED: _ yl (-,m ,0
ADDRESS OF SITE SERVICED: 2 ua-N
PLUMBING PERMIT IF APPLICABLE: #
TESTER LICENSE NUMBER: S EXPIRES:
DATE OF LAST TEST GAUGE CALIBRATION:
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
UBLE CHECK c ATMOSPHERE VACUUM BREAKER
MANUFACTURER: I Ni \16 V 6 SIZE:
MODEL: - �p SERIAL NUMBER: 1� !S Im Lo
puvslrnl I r)rATION OF METER:
I ne a)JUVU 1s cenuMrU LU uC uua-
�� �I 111
TESTERS FIRM NAME: ,� �
ADDRESS: CITY /STATE /ZIP: (�-�'1 >�C �GI�,� -77 2,26Y
- - -DATE. - -_ .0 - -Z 1.�. __ - _ - ..__._____P_HONE_N.U.MBER:- - �,3 `f Z
PRINT NAME: ��rr/ SIGNATURE:.
DOUBLE CHECK VALVE INSPECTION MUST BE CALLED FOR INSPECTION AT (817) 410 -3010'
C.XD000ME-11sbate \LOCALS- 11TemplXPgrpwise%TCEQ BACKFLOW TESTER REGISTRATION.doc
111310018.. 4/05,1106.2/10
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BREAKER
DOUBLE CHECK
ASSEMBLY
VALVE
RELIEF VALVE
AIR INLET
CHECK VALVE
1sT CHECK
2ND CHECK
Open at _psid
Did not open
psid
Leaked
Initial
DC- Closed Tight
_RP -3.(3 psid
Closed Tight
"Z:. �> .
Opened at
Test
Leaked
Leaked
psid
Repair
Materials
Used
Test
After
Repair
DC- Closed Tight
RP _ psid
— Closed - Tight—
Opened at
psid
Opened at
psid
psid
I ne a)JUVU 1s cenuMrU LU uC uua-
�� �I 111
TESTERS FIRM NAME: ,� �
ADDRESS: CITY /STATE /ZIP: (�-�'1 >�C �GI�,� -77 2,26Y
- - -DATE. - -_ .0 - -Z 1.�. __ - _ - ..__._____P_HONE_N.U.MBER:- - �,3 `f Z
PRINT NAME: ��rr/ SIGNATURE:.
DOUBLE CHECK VALVE INSPECTION MUST BE CALLED FOR INSPECTION AT (817) 410 -3010'
C.XD000ME-11sbate \LOCALS- 11TemplXPgrpwise%TCEQ BACKFLOW TESTER REGISTRATION.doc
111310018.. 4/05,1106.2/10
WARFORD IRRIGATION & LANDSCAPE, INC.
DBA SOAK -N -GROW
PO BOX 836
WHITEWRIGHT, TX 75491
OFFICE 903 - 364 -2634 FAX 903 - 364 -2912
Date: 8/24/15
The irrigation system installed at 1082 Lavon Dr has been installed 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.
Sincerely,
Kurt Warford
OF
•: * gad
......••r.... •........ .. P
.... ILLIAM K WARFORp
......................... Of
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