HomeMy WebLinkAboutPLIRR2015-1910CITY 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 LO TED:
ADDRESS OF SITE SERVICED: MD, i V'
PLUMBING PERMIT IF APPLICABLE: # L 1 I
TESTER LICENSE NUMBER: EXPIRES:
DATE OF LAST TEST GAUGE CALIBRATION: I
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 ATMOSPHERE VACUUM BREAKER
MANUFACTURER: -- 1C,�� SIZE:
MODEL: s E�RIIAL NUMBER:
PHYSICAL LOCATION OF METER: VV
ine above is cerunea to be true.
TESTERS FIRM NAME: / YAJc— ! V (JMLAJ
ADDRESS: CITY /STAY /ZIP: !,i(l`filG�i1GW1�
_..
DATE: PHONE NUMBER: (q6-3\ :3(,C/— _ (V3
PRINT NAME: SIGNATURE:
DOUBLE CHECK VALVE. INSPECTION MUST:BE CALLED FOR INSPECTION AT (817) 410 -3010
C:\D000ME- 1\sbatte \LOCALS- 1 \TemplXPgrpwise \TCEQ BACKFLOW TESTER REGISTRATION.doc
1113100 1Rev. 4105, 1105, 2110
REDUCED PRESSURE PRINCIPLE ASSEMBLY.
PRESSURE VACUUM BREAKER
DOUBLE CHECK
VALVE
AIR INLET
CHECK VALVE
ASSEMBLY
RELIEF VALVE
1ST CHECK
2ND CHECK
Open at_ psid
psid
DC- Closed Tight
Closed Tight
Opened at
Initial
_RPS•O psid
'Z
Did not open
Leaked
Test
psid
Leaked
Leaked
Repair
Materials
Used
— Test -
-DC- Closed - Tight- -
— -- Opened -at -
-Opened- at —__ -_
- - -_ _ _ —_— __
Closed Tight
After
psid
Repair
RP _ psid
psid
psid
ine above is cerunea to be true.
TESTERS FIRM NAME: / YAJc— ! V (JMLAJ
ADDRESS: CITY /STAY /ZIP: !,i(l`filG�i1GW1�
_..
DATE: PHONE NUMBER: (q6-3\ :3(,C/— _ (V3
PRINT NAME: SIGNATURE:
DOUBLE CHECK VALVE. INSPECTION MUST:BE CALLED FOR INSPECTION AT (817) 410 -3010
C:\D000ME- 1\sbatte \LOCALS- 1 \TemplXPgrpwise \TCEQ BACKFLOW TESTER REGISTRATION.doc
1113100 1Rev. 4105, 1105, 2110
WARFORD IRRIGATION & LANDSCAPE, INC.
DBA SOAK -N -GROW
PO BOX 836
WHITEWRIGHT, TX 75491
OFFICE 903 - 364 -2634
Date: 9/28/15
FAX 903 -364 -2912
The irrigation system installed at 1210 Huron 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,
6La-WftJvJ
Kurt Warford
OF
.......
p.............................
WILLIAM K WARFORD
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