HomeMy WebLinkAboutPLIRR2024-004270Texas Commission on Environmental Quality
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_Re foilovrin_ fTn iynN com,leted for each i® tested- A sig-ied and dated original must be submitwd to ffie ublic water su, lier for rCCoTdkMr'in'_ *, U1 0='
NAlvfE OF PWS: _.Gra,.,e%ane
Piws U)#-
PWS MAILING ADDRESS:
PWSCON TACTPERSON: -7 Backflow Coordinator
A�bbRESS O�ShRVICE- 308. -Tills, ery-Cir
The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations
and is ceWfled to be opga"t: wi in accepj�e p�jaTj th qte sj
TYPE OF BACKFLOW PREVENTION ASSEMBLY MPA
Reduced Pressure Principle (RPBA) 0 Reduced Pressure Principle -Detector (RPBA-D) Type 110
V Double Check Valve (DCVA) 1 10 Double Check -Detector (DCVA-D) H
El Pressure Vacuum Breaker (PVB) .0 Spill -Resistant Pressure Vacuum Breaker (SVB)
Manufacturer: main: Wilkins ass-; Size: Main: Bypass: 1,
Model Number: Main: 350 Bypassfl PA L:�ation :J Front
S
Serial Number. main:, AJBGS,712BYPa-;sV -1-BEPA es- Irrigation
PERMIT NUMBER: 24-004270
Reason for test: lNew
:V Existing D Replacement Ell O1dModeI1Scria1#j
Is the assembly installed in accordance with manufacturer recommendations andlor local codes. NO
10 jVes j)JI!o Is the assembly installed on a non -potable water supply (auxiliary)'?
'TEST RESULT Type H
Reduced Pressure Principle Assembly (RPBA) Assembly PVB & SVB,
P
PAS9 8(i DCVA
Che Relief Valve Bypass Check Air Inlet ck a1ve
FAIL 0 1,' Check 2' Check*
'ps J psid Held at
lidtial Test "Heldat 2.1 �psi 'Held at,2A.3 psid Opened at _'i jl� Held at id Opened at,
—Closed Tight rht ::Didnotopen 1[j paid
t, i psid
Closed Tight Closed Tight '0
Time: l,'Did not :0a.
.0 Leaked
Leaked 'Leaked Did fitfully open
05:30 pM Leaked 01 0
open
(YesI 01)
. . ..........
Repairs and �:Main:'
Materials
Used" Bypass:
1LLTest After Held at psid Held at psid Opened at I ��Held at; i psid Opened at' psid Held at
MR2 air :�ClosedTight D Closed Tight q;➢��psid jClosed psid
D7 ate:
jight U
Time:
21 check. numeric reading recittired for DCVA on1%
Differential press e gauge used: Potable: V Non -Potable'. El'
m . aketmodei: Midwest - 845 1 -5 sN: 0 1 .. i5l 51A Date testa- , d I for accuracy I 11 ''06/28/2o24
Company Name: Classic Backflow, LLC Licensed Tester ame
NCharl�, .!`is-
(Print/Tv,.,
Company Address- ;3025 Oak Meadow Dr Licensed Tester Name (Signature):
Flower Mound, TX 75028
Company one BPAT License # I BP0016431
1214-535-3341
License Exi tion Date: 03/17t2O27
The above is certified to be true at the time of testing.
TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS [30 TA C §290.446(B)]
** USE ONLY MANUFACTURER'S REPLACEMENT PARTS
TCEQ-20700 (Revision 04-04-2019) Page 1 of 1