HomeMy WebLinkAboutPLBG2023-001447M3[U2K&j
PO Box 95104 Project# 23-001"7
Grapevine, Texas 76099
817) 410-3166 Project Description: Replace double check to building main
Trost Bank"
Issued on: 05/0512023 at 4:48 PM
ADDRESS
INSPECTIONS 3
975 W Dallas Rd.
1. TCEQ Backflow Certification Submit 3. Plumbing Final
rapevine
G, TX 76051
2. Backfiow Device Inspection
LEGAL
I bell ire Addition Blk I
INFORMATION FIELDS
Lot Ar
S
VALUATION 500
Frost Bank
FEE TOTAL PAID DUE
PERMIT HOLDER
Plumbing Permit Fee {VALUE} $37.00 $37.00 $37.00
Terry Watts
Emergency Plumbing Se
TOTALS $37.00 $37.00 $ 0.00
rvices
(817) 329-0223
The granting of this permit does not presume to give authority to violate or cancel
the provisions of City, State, or other local laws regulating construction or the
COLLABORATORS
performance of construction. All provisions, laws, and ordinances governing this
® Terry Watts
type of work shall be complied with, whether specified or not and shall be enforced
Emergency Plumbing
at any and all times.
Services
(817) 329-0223
Page 1/1
MYGOV,US 23-001447, W0512023 at 4.48 PM Issued by: Connie Cook
Texas Commission on Environmental Quality
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCEREPORT
The, following form must be corn feted for each assembl, tested. A si ned and dated orL inal must be submitted to the ublic water su Mier for recordkee; in "; a ores:
..
N E OF PWS:
PWS ID#:
PWS MAILING ADDRESS:
PWS CONTACT PERSON:
ADDRESS
t
OF SERVICE.
The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations
and is certified to be oi>eratin� within accertable parameters.
TYPE ACL PREVENTION ASS Y A):
_.._ Reduced Pressure Principle RPBA _. Press __...__....,. ....._....... __.......,
Reduced Pressure Principle -Detector (RPBA-D) Type II EJ
❑° Double Check Valve (DCVA) Double Check -Detector (DCVA-D) Type II ❑
Pressure Vacuum Breaker (PVB) Spill -Resistant Pressure Vacuum Breaker (SVB)
Manufacturer: Main: ,.. Bypass:Size: Main: Bypass:
Model Number: Main: l " B ass: BPA Locationi
Serial Number: Main: ::: Bypass: BPA Serves:
Reason for test: ExistingReplacement New Old Model/Serial #. ,
Is the assembly installed in accordance with manufacturer recommendations and/or local codes? El Yes ❑. No
Is the assemblyinstalled on a non -potable water supply P .PF Y (auxiliary)? 1 Yes : t❑ No
TEST RESULT" _m._..,� TYPe II _...�..____��._.............�
�
Reduced Pressure Principle Assembly ( BA) it Assembly
PVB & SVB
PASS DCVA
Relief Valve ,.Bypass Check f Air Inlet v Check Valve
FAIL El 1" Check _i 2nd Check***
Initial Test iHeld at",� psid Held at,,., psid „Opened at .Held at psid'Opened at psid ,Held at
Date " % Closed Tight igClosed Tight i p psid IClosed Tight ❑ ieDid not openpsid
Timc:., .,. t Y l Did not E'. ❑ Did it full o en
Leaked 'Leaked ❑ tfLeaked
P
open
"(Yes/No ) kiLeaked
Repairs and
Wain:
Materials
Used** ,Bypass:
........ .................. .._...-._.,..., .,....b^.',«..—.^.«�..".'�"C.......„....---"-».`.,,,.......m...,,..,.....,.«..,.._._.......» ...,..X
Test After
{.«..®�«.......».,.....«.
Held at psid ,Held at psid :
Opened at'_ „Held at psid ,Opened at psid °jHeld at
Repair ;IClosed Tight Elj Closed Tight i
psid „Closed € !psid
Date: (
Time: a f
yTight
*** 2"d check: numeric readint, rS wired for DCVA onl . _
_...,... ,._.._._........ �__..__...._.. ,a.µ.._
Differential pressure gauge used:
j Potable: 1 Non -Potable:
g
hMake/Model: Mid -West 845-5 SN i 08191248 Date tested for accurac, : 8/9/2022
_ . _ ......W. _. — .
j
-. �. Remarks:
Company Name: ester Name
Wise Water Solutions
(iriUsTed
David l0 1 ei)burgl,
Company Address: 309 Hobbs S p y t Licensed Tester Name (Signature): j
_ ..._.. Boyd, TX 76023
Company Phone #: BPAT License_# BP '719401 ........ .
817-988-3791
License Expiration Date: 3/2025
s 08 1
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)]
** USE ONLY MANUFACTURER'S REPLACEMENT PARTS