HomeMy WebLinkAbout2025-002457Texas Commission on Environmental Quality
C ustorne r -Service Inspection Certificate
Name of PWS: cit°, of Grapevine
PWS ID mboi'
.Location of -'A I C",
...... . . . ...... .
Reason for Inspection: New construction ... .......... ...... ........... ...... ......... ............ ... M
Existing service where contaminant hazards are suspected ............ . J
Major renovation or expansion of distribution facilities ..................... 0
I V C t t C. I j , upon inspection of the private water distribution facilities
connected to
r the aforementioned public water supply do hereby certify that, to the best of my
knowledge:
Com,.,tiance
Non-Com, fiance
X
No direct connection between the public drinking water supply
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.
:(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 back ow
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.
(5) Plumbing installed after January 4, 2014 bears the expected
labeling indicating 50.25% lead content. If not properly labeled,
please provide written comment.
(6) No solder or flux which contains more than 0.2% lead exists in
private water distribution facilities installed on or after July
1,1988.
J further certify that the following materials were used D-1`14e installation of the private water distri•ution facilities:
Service lines; Lead El Copper FT� PVC 0 Other I;�enl
Solder; Lead 0 Lead Free ��Solvent Weld I-] Other B--1'-
I recognize that this document shall become a permanent record of the aforementioned Public Water System and
that I am le;all res-l-r'yonsible for the validity of the information I have
Remarks: Existing plumbing may have been installed without permits inspections and therefore cannot be verified.
.. .. . .......... ...
It is impossible to verify com,']iance of existing ;Numbing which is covered by building construction.
Signature of Inspector:
Title: lns;),ector
Date: %
License Number:
Type of License: Plumbln�-,,, Inspector
0:FormsXTCEQ-20699\04-17-17