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Home My WebLink AboutPLBG2016-127641, 11 P CITY OF GRAPEVINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: GRAPEVINE PWS I.D.# 2200013 NAME OF BUSINESS WHERE E ADDRESS OF SITE SERVICED: PLUMBING PERMIT IF APPLICj TESTER LICENSE NUMBER: DATE OF LAST TEST GAUGE ( ANNUAL TEST IRRIGATION OTHER Z. 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: bi SIZE: MODEL: F pnd. Q SERIAL NUMBER: 1PU 75) PHYSICAL LOCATION OF METER: The above is certified to be true. TESTERS FIRM NAME: ADDRESS:5DOE) CITYISTATEIZIP: 77, 762,07 DATE: A PHONE NUMBER: 1-4-36 7 PRINT NAME: 13 6 SIGNATURE /7 DOUBLE CHECK VALVE INSPECTION MUST BE CALEDFOR INSPECTION AT (817)410-3010 C,\DOCUM%l�,�.ft4LOCALS-1\Temp\XP�g�,s,,TCEQ BACKFLOW TESTER REG1STRATDN.dm 1113100/R— I V06,2110 REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER DOUBLE CHECK VALVE ASSEMBLY RELIEF VALVE AIR INLET CHECK VALVE IST CHECK 1ST CHECK D 2 N 2 ND CHECK CH CHECK C K Open at _ psid psid DC CIO d Tight pea i g. C 10 d Closed Closed Tig ig Initial —1� psid P ; Opened at Did not open Leaked Test Leaked Leaked Leaked IL psid Repair Materials Used Test DC -Closed DC -Closed Tight Tight Opened at Opened at After er Closed Tight psid Repair RP _ psid psid psid The above is certified to be true. TESTERS FIRM NAME: ADDRESS:5DOE) CITYISTATEIZIP: 77, 762,07 DATE: A PHONE NUMBER: 1-4-36 7 PRINT NAME: 13 6 SIGNATURE /7 DOUBLE CHECK VALVE INSPECTION MUST BE CALEDFOR INSPECTION AT (817)410-3010 C,\DOCUM%l�,�.ft4LOCALS-1\Temp\XP�g�,s,,TCEQ BACKFLOW TESTER REG1STRATDN.dm 1113100/R— I V06,2110 A F01 mlwm�•' �,Lm BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OFPWS: GRAPEVINE ANNUAL TEST IRRIGATION PWS I.D.# 2200013 A OTHER NAME OF BUSINESS WHERE DEVICE IS LOCATED: lk r) ADDRESS OF SITE SERVICED:.. PLUMBING PERMIT IF APPLICAB LE: # TESTER LICENSE NUMBER: ,0 F k) D I Lt) to qL- EXPIRES: DATE OF LAST TEST GAUGE CALIBRATION: /1-/3- / 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: SIZE: MODEL: SERIAL NUMBER: PHYSICAL LOCATION OF METER: The above is certified to be true. TESTERS FIRM NAME: A,L . ADDRESS: 500D )5V=V'Q'4 Pi, �/'IDZ) CITY/STATE/ZIP: _e" '76 & 7 DATE: —PHONE NUMBER: PRINT NAME: - j4gAa� 13o) � -101%.- SIGNATURE: DOUBLE CHECK VALVE INSPECTION MUST BE CAI 4=n FOR INSPECTION C'.�DOCUME�INOS.batte\LOC.ALS—IkT�pNXPgrpwisekTCEO BACKFLOW TESTER REGISTRATION.doc 11n=1R 1 .1106,2110 L�i \/\A\ � Lf 1A 4 D V%"\- REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER DOUBLE CHECK VALVE ASSEMBLY RELIEF VALVE AIR INLET CHECK VALVE 1ST CHECK 2ND CHECK Open at _psid psid DC -Closed Tight Close:dTig Closed Tight Initial RP -7 sid Opened at p Test zj p T� Did not open Leaked Leaked Leaked Repair Materials Used Test DC -Closed Tight Opened at Opened at After Closed Tight psid Repair RP _ psid psid psid The above is certified to be true. TESTERS FIRM NAME: A,L . ADDRESS: 500D )5V=V'Q'4 Pi, �/'IDZ) CITY/STATE/ZIP: _e" '76 & 7 DATE: —PHONE NUMBER: PRINT NAME: - j4gAa� 13o) � -101%.- SIGNATURE: DOUBLE CHECK VALVE INSPECTION MUST BE CAI 4=n FOR INSPECTION C'.�DOCUME�INOS.batte\LOC.ALS—IkT�pNXPgrpwisekTCEO BACKFLOW TESTER REGISTRATION.doc 11n=1R 1 .1106,2110 L�i \/\A\ � Lf 1A 4 D V%"\- CIW OF GRAPEVINE BACKFLOW PREVENTION ASSEMBLY TEST 14L NAME OF PWS: GRAPEVINE PWS I.D.# 2200013 NAME OF BUSINESS WHERE DEVICE IS LOCA ADDRESS OF SITE SERVICED: 1 -4� r) n PLUMBING PERMIT IF APPLICABLE: TESTER LICENSE NUMBER: DATE OF LAST TEST GAUGE ANNUAL TEST IRRIGATION OTHER 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:_ 1�_ SIZE: MODEL: SERIAL NUMBER: PHYSICAL LOCATION OF METER: I ne above is certitied to be true. TESTERS FIRM NAME: CR� IAL �vvrcLoa s ADDRESS:5000 ffW'Plf, —d/bO CITY/STATE/ZIP: ff �— TX 76Z,0(7 DATE:— PHONE NUMBER: PRINT NAME: SIGNATURE: DOUBLE CHECK VALVE INSPECTION MUST BE CA GED FOR INSPECTION AT(817)410-3010 C.IDOCUME-IX.SbafteV-OCALS-IXTemp�XPgrpviseITCEQ BACKFLOW TESTER REGISTRATION.doc 1113J001R-4105, 1106, 2110 �# �� fir ;� �, i�� k,l��, UC REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER UB DOUBLE OUBLE CHECK VALVE ASSEMBLY RELIEF VALVE AIR INLET CHECK VALVE ST C ' CHECK CK No 2 CHECK Open at _ psid psid DC -Closed fight Closed TjghO Initial I 74Spsid Opened at Did not open Leaked Test 9 q Leaked Leaked PC_�,D psid Repair Materials Used Test DC -Closed Tight Opened at Opened at After Closed Tight. psid I Repair RP _ psid psid psid I ne above is certitied to be true. TESTERS FIRM NAME: CR� IAL �vvrcLoa s ADDRESS:5000 ffW'Plf, —d/bO CITY/STATE/ZIP: ff �— TX 76Z,0(7 DATE:— PHONE NUMBER: PRINT NAME: SIGNATURE: DOUBLE CHECK VALVE INSPECTION MUST BE CA GED FOR INSPECTION AT(817)410-3010 C.IDOCUME-IX.SbafteV-OCALS-IXTemp�XPgrpviseITCEQ BACKFLOW TESTER REGISTRATION.doc 1113J001R-4105, 1106, 2110 �# �� fir ;� �, i�� k,l��, likt CITY OF GRAPEVINE PWS ID# 2200013 WATER CUSTOMER SERVICE INSPECTION CERTIFICATION DATE: 4)1 �1 0 BUILDING ADDRESS: SWIMMING POOL � ��O .+��j„�.�f ,Q� IRRIGATION PERMIT # 16 " 1.)--2(j WATER NEATER PLUMBING I hereby certify that I have inspected the water supply system at the above referenced address. To the best of my knowledge, the materials and methods used in the installation of this system comply with all laws of the State of Texas relating to plumbing that are required to be enforced by municipalities, and the plumbing code adopted by the City of Grapevine. Plumbing regulations are contained in the City of Grapevine Code of Ordinances Article V (Ordinance number 2007-36) and Article VIII (Ordinance number 2007-36), and any and all subsequent related ordinances. In addition, to the best of my knowledge, no cross connection exists at this address at the time of inspection. SI NAT F I E TITLE LICENSE NUMBER OAforms\waterservinsp, 05/01 Revised: 7123114