HomeMy WebLinkAboutSWP2022-002431Texas Commission on Environmental Quality
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REI"RT
Tbefoltov4nt form must be comActed for each assmbE tested. A siti, wd and dated ori6rW must be submitted to the *vuif=eses;
NAME OF PWS: City of Grapevine
PWS MAILING ADDRESS: 0 BOX 95014. Grape 9 i9e, TX 7509 vi -------
PW,S CONTACT PERSON:
m.
irjq Inspection
S OF
SERVICE: ERVICE:
i 2149 ul
Anderson Gibson Rd The Carter Apts
The backfiow prevention assembly detailed below has been tested and maintained as required by comrmssion regulations
and is certified to be operatin,,i within acceptable parameters.
TYPE OF BACOW PREVENTION ASSEMBLY
R Reduced Pressure- Piincip_1e(PBA) 0
Reduced Pressure Principle -Detector (RPBA-D) Type 1110'
Double Check Valve (DCVA)
0 Double Check -Detector (DCVA-D) Type 1101:
Pressure Vacuum Breaker (PVB) I[] Spill -Resistant Pressure, Vacuum Breaker (SVB)
-katw Manufacturer: 1 Main: it Wilkins Bypalls:ij Vi 3/e am7T
Model Number: I Main:! 1 375 Bypass.'l BPA Location: i i Back side amenity bidg at BLDG
P
Serial Nuinber: it Main:1 AJAE6205 Bypass,fl B Serves: Pool Autofill
Reason for test: I New i Existing Replacement 0 Old Model/Serial
Is the assembly installed in accordance with manufacturer recommendations and/or local codes?
Is the assembly installed on a no-n-pot—able-w—at--e-rs--u—pp-1-y -(-auxiliary)? '01YcssI N. No
TEST RESULT
Type 11
Reduced Pressure Principle Assembly (RPBA)
Assembly
PVB & SVB
I
AS
PASS
DCVA
FAIL 03
Relief Valve
1 kr Check I 2nd Check***
Bypass Check
Air Inlet
Check Valve
Initial Test lHeld at L110A psi!Held ati, .4, psf 1 Opened at
C psi
Date: 00/1812023 Closed Tight
Held at psid
Closed Tight �'o
Opened at pSid
Dirt
Held at
psid
!Closed
IDid
not o Pen
,'04
Time-, - 15 PM
not.
11,caked
Leaked to 1
Leaked 0
�'Did it fully open
Leaked i
jopen
(yes /No
Repairs and
Materials
Used"
1,111ypass:
Tes -'---][[
Held at Held at psid a, I — ; Id a
PC He t! psid Opened at Held at 1
ReRair
Tight P,
Closed Closed Tight
'Closed psid
Date:
Tight
214 check: numeric readin , reo uired for DCVA ME
Differential pressure gauge used: 'Potable: Non -Potable: 1111
LMake/Model: � Midwest845-5 01151514 ab�!� �tedfot� accu�aey 1 08/09/2,1
Remarks.
i Company Name: Licensed Tester Name
Classic Backfiow, LLC �pjjntrrN)e): Charles
Company Address: 3025 Oak Meadow Dr Licensed Tester Name (Signature):
Flower Mound, TX 75028
BPO Company Phone 4- BPAT License # 0164
31
214-535-3341 _L�. c en se E x I ira tion Date: 11 : 3/17/2024
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 of2