HomeMy WebLinkAboutPLIRR2024-004268Texas Commission on Environmental Quality
7.131t
_Re fbfloy�n form must he can leted for each aganifl, . tested. A gi;=,ied and dated oriEinal must be submitted to ft. ublic watersu Bier for r=rdk-c0n-_ *,,u& -o=
NAME OF PWS: Gra: in
PWS ID#:
PWS MAILING ADDRESS: _5015hady Br.Qok
PWS CONTACT PERSON: Back1low Coordinator
,P�DDRESS OF SERVICE: 316 Tillgry,Cir
The bacow prevention assembly detailed below has been tested and maintained as required by commission regulations
and is certified to be opera. Ec wit�in acqp-ptabl qerL_
TYPE OF BACKFLOW PREVENTION ASSEMBLY (BPA,:
Reduced Pressure Principle (RPBA) 0 Reduced Pressure Principle-Det(RPB ector A-D) Type 11 .
Vey.® 01
V Double Check Valve (DCVA) Double Check -Detector (DCV-D) T� r e H 11
Pressure Vacuum Breaker (PVB) Spill -Resistant Pressure Vacuum Breaker (SVB)
Manufacturer.- main: Wilkins Bypass- I Size: in: Bypass: 1;
Model Number: main: 350 BypassJ1 _WBPA on: Front
SeX seryLocatirial Number- Main: AJAD7636 Bypasses: Irrigation
-
PERMIT NUMBER: 24-004268
Reason for test: New Existing 0 Replacement jOldModel/Serial#1 I
Is the assembly installed in accordance with manufacturer recommendations and/or local codes? es '10'No
Is the assembly installed on a non - potable water supply (auxiIiary)? ea
;Yes
TEST RESULT Type H
Reduced Pressure Principle Assembly (RPBA) Assembly PV`B & SVB
PA SDCVA S
else ve Bypass Check Air Inlet i! Check Valve Rf Val
FAEL 0 V Check 2nd Check***
Held at Paid'Opened at: id,� Held at
jwtiai Test i�Heid at 2 3 psi :2.4 � JI
Held a� _] psid Opened at' ps
psid.
Date-12115/2024 ;,Closed Tiigrht Closed Tight psid Closed Tight El Did not open lb
"Time: id not ti
05:20 PM i'Leaked Lcakcd 'Leakud 0 Did it &I.Ily open Leaked
open 10' (YesID/No,
1 7777
Repairs and :;Main-';
Naterials
d]Used** Bypass:
Test After Held at sr ''field at paid Opened at t! Held at psid::�'Opened at psid: Held at
lClosed paid
„._.�....
K& air psid
Closed Tight [2 Closed Tight
ate:JTfight D
Ti4 me:
2nd cheek. net readine recuired for DCVA onle
Differential pressure gauge used: Potable: Non -Potable:
maketmodei: Midwest 845-5 SN: 01.151,514 Date tested for accuracv': 06/2812024
Remarks;
Company Name: Classic Backflow, LLC. Licensed Tester Name
PrintlTy ): Charles
C® Address: ,3025 Oak Meadow Dr Licensed Tester Name (Signature):
flower Mound, TX 75028
i - I
Company Phone 1 214-535-3341 BPAT License # I BP00164-31
License Exi.iration Date: 03/1712,027
The above is certffled to be true at the thine of testift.
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 of I