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Home My WebLink AboutREA2023-001110Name of PWS: City of Grapevine PVV8 ID #: 2200013 IWA R 4 Location of Service: TF 1 1A Reason for Inspection: New construction ....... _ ............. ............... Existing service where contaminant hazards are suspected,,.. 0 Major renovation or expansion of distribution 0 I T J�'tl upon inspection of the private water distribution facilities connected o the aforementioned public water supply do hereby certify that, to the best of my knowledge: Comp,liance Non-Corn;'."Iiance (1) No direct connection between the public drinking water supply L-1 and a potential source of contamination exists. Potential sources of contamination are isolated from the public water system by an air gap or an appropriate backflow prevention assembly in accordance with Commission regulations. 1(2)'! No cross -connection between the public drinking water supply and a private water system exists. Where an actual air gap is not maintained between the public water supply and a private water supply, an approved reduced pressure principle backflow prevention assembly is properly installed and a service agreement exists for annual inspection and testing by a certified backflow prevention assembly tester. (3) No connection exists which would allow the return of water used for condensing, cooling or industrial processes back to the public water supply. (4) No pipe or pipe fitting which contains more than 8.0% lead exists in private water distribution facilities installed on or after July 1, 1988 and prior to January 4, 2014. Plumbing installed after January,4, 2014 bears the expected labeling indicating fig. 25% lead content. If not properly labeled, please provide written comment. No solder or flux which contains more than 0.2% lead exists in private water distribution facilities installed on or after July 1,1988. I further certify that the following materials were used ! he installation a e private water distribution faciNties', Service lines; Lead 0 Copper OK PVC Other 0 Solder; Lead 0 L.ead Free 0 So!ventWeIdD Other 0 I recognize that this document shall become a permanent record of the aforementioned Public Water System and that I am Ieually res� onsible for the vaiidir"r of the information I have i rovided. Remarks: Existing plumbing may have been installed without permits/ inspections and therefore cannot be verified. it is impossible to verify com;,Aiance of existing plumbing which is covered by building construction, Signature of Inspectoc 14� —I—L/, License Number; Inspector Type of License: Plumbing Insoector Date: Texas Commission on Environmental Quality BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT Tre friflovi!�_ 1=1 mustty"Corni for tach",semb)-. jested. A si-gied and dat�d oneml mu�A hesubmww.0 iuEhe ubhc water -M for recuq1kocz ing sty: NAME OF Pli Gra,,,,evine PWS MAILING ADDRESS, PWS CONTAcr PERSON: Backilo..w Ci rdinoatr ";� 11- 1. e- 11 . ADDRESS OF SERVICE: The backflow prevention assembly detailed below has been tested find rruum'.:iincd as required by commission regulations and is certified to be operating within acce�eta ble peratnetem TYPE OF BACKFLOW PREVENTION ASSEMBLY (BPA): Reduced Pressure Principle (RPBA) Reduced Pressure Principle -Detector (RIBA -Di Tyke. if El 0` Double Check Valve (DCVA) 0 Double Check -Defector (DCVA-D) Type 11 —4 Pressure Vacuum Breaker (PVBl 0 Spill -Resistant Pressure Vacuum Breaker (SV.B) Manufacturer. Main: Size: Main: 1�� f, Bypass:i Bypa�&, Mod.cl Number- Mai W L_.Ff_1 616"" 1 ass. BPA Location: 46 -vz r Serial Numl.7er.- Main; &zr� q IF Bvass�� 8PA Serves - PER MITN UMBER- 23-W11110 Reason for test: ' New 21 - Existing 0 Replacement 0 Old Model/Serial # Is the assembly installed in accordance with manufacturer r�corumendations and/or local ewes? :0 yes No Is the assembly installed on a non -potable, water supply (auxin ary)? 0 Yes NO 'TESESULT 9 Type Il Reduced Pressure Principle Assembly (RPBA) Assembly PVB & SvB PASS.' 0 DCVA Valve Relief Valve Bypass Check I Air Inlet Check V,alve FALL V Check 2" Check**-* ti Irfitial Test field at -TtL pizid field at' psid Wpened at-3JO, [Held at ---------- l4eld at PFid Opened at p Date:,gPif'JClos,ed Tight Closed Tight � Psrd iClosod Tight �,4Did not open ght jpsid Did not Time: [] 4 Did it fully open Leaked Leaked 0 Leaked 0 1,4aked Open 01 1(yes 0 iN Repairs and `%'Wl in n: Materials Used-'11* Bypass: Test. After Held at psid 16 field at id psid i(livned at Held at: ps Opened at psid I! Held at air Y Closed 1 psid ;.Closed 0 Closed Tight 0:; Ps' Date: Iu�Tight Time: 2"' check. numeric readin�,�, re'Auired for DCVA ern Differentia! premure gauge used- Potable: Non-lacdable� 0' i Make oriel: Midwest/845-5 SN: 1 22k644-- bate tested for accurac 12/12/23 Company Name. Licensed 'rester Nartic Atlas Backflow I Chaz Richie Company Address: 3 i 7 Trice St, il Licensed Tester Name (Signature): Maypearl Tx 76064 Company Phone BPAT Le-nse 214-519-4410 License ExI trat 11 i I on Date: I 1 1 1 1812025 Tice above is certified to be true at the time of testing. TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS [30 TAC §2( )GA15JI)j ** USE'ONLY MANI IFACTURER'S REPLACEMENT PARTS TCEQ-20700 (Revision 04-04-2019) Page t of I Texas Commission on Environmental Quality BACKFLOW PREVENTION ASSEN18LY TEST AND MALN'TENANCE RFPORT The fbllowlrlb figm I _ 4 C _va�le_f 1112sst he col) WF Lach assernbk teqiW. As�ened dud duel original rmst be subtr tied ip the �uhh wacT s f�lr mcor"Wee in - nqf,.�� NAME OF PWS: Grar:�evine PWS U)#- PWS MAILING ADDRESS: PWS CONTACT Back4ow. Coordinator ADDRESS OF SE R VICE The backflow prevention assembly detailed Wow has been tested an maintained as required by commission regulations and is certiried to be qj.-Tr4t within acceptable p aqem TXPE OF BAC.KFLOW PREVENPONASSENIBLY (BPA)-. Reduced Pressure Principle (RPRA) El Reduced Pressure Principle -Detector (RPBA-D) Type If 0 0, Double Check Valve (DCVA) 0 Double Check -Detector (DCVA-D) Type 11:0 0. Pressure Vacuum Breaker (PVB) 0 Spill -Resistant Pressure Vacuum Breaker (,SVB) Manufacturer: Main: G,j,144S BypassSize- Maiw j Bypass: Model Number- Maim _Lr,0oqma 13ypa.,,;,;J, BPA Location: k- Serial Number: Maln: 3180(ol Bypass,' i BPA Serves- 1, PERMIT NUMBER- Ito Reason for tesc �i New 19 Existing Cl Replacement 0: Old Model/Scrial 4 Is the assembly installed in accordanec with manufacturer recommendations andfor local codes? M Yes 10, No Is the assembly installed tin non -potable water supply (auxiliary)? �;0 ye-s t4 NO TFST RESI JIX Type I Reduced Pressure Principle Assembly (RPBA) Assemblv Per B & SVB P DCVA A S,�, 01 Relief Valve'Bypass Check Air Inlet Check 7Valve FAIL 0 J'Check 2" Check" , Initial Test °Hcld at,%= -it'. =)pened at Held at at paid Held at psid psidqOpcned, 5 Dat-_-,249V/1'V "'Closed Tight 0 �Closed Tight Z: Psid 1j,Closed Tight El I Did not open -4psid 6 Did trot 1Di 'Jlxaked Leaked d it fully open, �i 1 Yes 11 /N10 Ol Repair,,, mid Main: Materials Used** Test After 'eHeldat— paid jMeldzit a ps Held at psid,,.10penedat p,-id I I jeld at id j0penedat_ air ;ClosedTi,,aht 111 Cloyed Tight 1 iPsid Closed Ipsid 04 Date: t jlTight 0 Time: 211� check: numeric readin, rccm'red for DCVA onk Differential pres-sure gauge used: Potable: 0 Makelklodel� Midwest/845-5 SN: 12220544 Date tested for accurac 12/12123 .. .. ... ... Company Name: i Licensed Tester Name Atlas Backflow had Richie Company Address: 317 Trice St, Licensed Tester Narne (Signature), Maypearl.TX760.64' Company Phone 9: B PAT License 4 BP0021750 214-519-4410 License Exljra'tion,.Datc� 111 /1812025 The aho've is certified to be t ' rue ' at the tune of testing. TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS [30 TAC §2'L)0,46(B)j t 1SE ONLY NIAWFACH lRFR'S REPLACEWNT PARTS TCEQ-207(0 (Revision 04-04-2019) page 1 of 1