HomeMy WebLinkAboutPLBG2023-001968ADDRESS
1807 Rolling Ridge Dr.
Grapevine, TX 76051
LEGAL
Shadow Glen Addition
Ph 2a & 2b Blk 10 Lot 10
A10
S220 10
*05840015*
PERMIT HOLDER
Stephen Harris
Berkeys
(817) 481-5869
COLLABORATORS
•Stephen Harris
Berkeys
(817) 481-5869
OWNERS
•Current Owner Current
Owner
INSPECTIONS 3
1. TCEQ Backflow Certification Submit
2. Backflow Device Inspection
3. Plumbing Final
INFORMATION FIELDS
**APPLICANT NAME (Individual)stephen harris
**APPLICANT PHONE NUMBER 8176548174
VALUATION 2300
Square Footage 1930
FEE TOTAL PAID DUE
Plumbing Permit Fee {VALUE}$ 57.00 $ 57.00 $ 57.00
TOTALS $ 57.00 $ 57.00 $ 0.00
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
performance of construction. All provisions, laws, and ordinances governing this
type of work shall be complied with, whether specified or not and shall be enforced
at any and all times.
City of Grapevine
PO Box 95104
Grapevine, Texas 76099
817) 410-3166
Plumbing Permit {VALUE}
Project# 23-001968
Project Description: replace 1- double check backflow device
in yard
Issued on: 06/02/2023 at 5:22 PM
MYGOV.US 23-001968, 06/02/2023 at 5:22 PM Issued by: Connie Cook
Page 1/1
Texas Commission on Environmental Quality I
&1ATJ..6,11XWXWM�11'T_V IV
The fr4lowin.. form must be q9nn� leted for each assernbl, tested. A si:med and dated ori.inal must be submirced to the oublic water sw, lier for recondkeeJw, u,703e,s:_
NAMEOFPWS: Citv of Grapevine
PWS TD#,.
2200013
WS MAILING ADDRESS: 501 Shady Brook
PWS CONTACT PERSON: Backflow Coordinator
ADDRE§§r6F,
SERVICE: SFD/ 1807 Rolling,f?idge Dr
Monica/ Berke's PU 682-216-7959
The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations
and is certified to be opjatinpr within acceotable ��arameters.
TYPE OF BACKFLOW PREVENTION ASSEMBLY (BPA):
■
Reduced Pressure Principle (RPBA) Reduced Pressure Principle -Detector (RPBA-D) Type H 0
Double Check Valve (DCVA)
Double Check -Detector (DCVA-D0
Pressure Vacuum Breaker (PVB)
Spill -Resistant Pressure Vacuum Breaker (SVB)
Manufacturer: ain: �-V'04�< Bypass:,
Size: Main:; ass:
Model Number: Main: Bypass: PA Location: 'r crcl
Serial Number: Main:
Bypass:' BPA Serves: 4
Reason for test: ' New X Existing 0 Replacement 0 OldModel/Serial#�
Is the assembly installed in accordance with manufacturer recommendations and/or local codes? lkl"Yes 0 No
Is the assembly installed on anon -potable water supply (auxiliary)? Yes Q1\0
TEST RESULT
Type 11
Reduced Pressure, Principle Assembly (RPBA) Assembly PVB &Sate... ...kl M .. ..,m-.,,«..,.,....::..:..A»:.......»n��_�___�_.. VB
PASS DCVA
Relief Valve i; Bypass Check °1� Air Inlet Check Valve
FAIL Ell! I` Check �heck***
Initial Test 1, Held at psid: Held all" psid :':Opened at Held at psid Opened at psid !)Held at
?Date,, !'psid
,Closed Tight Closed Tight Closed Tight 0 :'Did not open
0 1 psid
Did not
Time5
;Leaked ,Did it fullyopen "1eaked
J)Leaked El ;Leaked11
��open
(Yes ONO
Repairs and IlMain:'
PIFUsed** ro Bypass:
191 _After jHeld at
psid `Held at psid Opened at �1 Held at psid
&P—a—ir ',IClosed Tight :aClosedTight 'psid �dClosed
Date: 4
'Tight El
Time:
2' check: numeric readinu iui d f DCVA I
or 1�� `
Differential pressure gauge used:
Potable: Non -Potable: Ell
(,Make„ 1/M.odel':_ Midwest 845-5 SN: jj�P531 Date tested for accurac
1
Remarks.
Opened at psid "Held at i
psid
Company Name- �.01 Accuracy Backflow Licensed Tester Name ar I ta ri 1- Cox
(Print/T6;e
Company Address:
Licensed Tester Name (Signature):
Po Box 6832 Mckinney, Tx 75071
Company Phone PAT License # BP0017066
972-699-7156 1 :
License Expiration Date: 2-23-25
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)l
** USE ONLY MANUFACTURER'S REPLACEME'_NT PARTS
TCEQ-20700 (Revision 04-04-2019) Page 1 of 1