HomeMy WebLinkAbout26-001428; 814 S MAIN STREET - BACKFLOW REPORTTexas Commission on Environmental Quality
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
Tlefoljowiw, form must be comp for each assembi, tested. A siii,ned and dated orii� inal must be submitted to the �,�ublic water su�lier for recordkee,',im, *lv I ases:
NAME OF PWS: Grapevine, TX
PWS ID#: 2200013
PWS MAILING ADDRESS: 501 Shady Brook.Pr
PWS CONTACT PERSON: backflow coordinator
ADDRESS OF SERVICE: 814 S Main St, Grapevine, TX 76051
The backnow prevention assembly detailed below has been tested and maintained as required by commission regulations
and is certified to be op, ratin.,, within acceptable j'arameters.
TYPE OF BACKFLOW PREVENTION ASSEMBLY, (BPA):
Reduced Pressure Principle (RPBA) El Reduced Pressure Principle -Detector (RPBA-D) Type H 11
Double Check Valve (DCVA) [I Double Check -Detector (DCVA-D) Type Il 0
Pressure Vacuum Breaker (PVB) Spill -Resistant Pressure Vacuum Breaker (SVB)
Manufacturer:
Main: Wilkins Bypass:
Size: Main: 1/21' Bypass:
Model Number:
Main: 975XL3 Bypass:
BPA Location: next to soda machine
Serial Number:
Main: ALA72832 Bypass:
BPA Serves: soda machine
R eason for test:
New Existing El Replacement
Old Model/Serial #
Is the assembly installed in accordance with manufacturer recommendations and/or local codes? 12 Yes 0 No
Is the assembly installed on a non -potable water supply (auxiliary)?
0 Yes 0 No
TEST RESULT
Type 11
Reduced Pressure Principle Assembly (RPBA)
P. Assembly PVB & SVB
PASS
DCVA
Relief Valve Bypass Check Air Inlet Check Valve
FAIL El
Check 21 heck*
I" C
Initial Test
- ------- ---
Held at 8.0 psid Held at 7.8 psid Opened at 1 3. 0 �i; Held at psid Opened at psi d Held at
D 4/20/26
Closed Tight Er Closed Tight psid
'Closed Tight 'Did not open sid
'pate:
T11:43 am'
nime:
eaDid
Leakd Leked
Leaked i: Did it fully open Leaked
not
�'ope
(Yes INo
Repairs and
ain:
Materials
Used"
Bypass:
Test After
Held at psW:I Held at sid f Opened at
P
Held at psid Opened at psi Held at
Repai
�,ClosedTight []�ClosedTight psid
Closed ��psid
Date:
Tight
TiII
me:
2nd check: numeric readin reouired for DCVA
on]
Differential pressure gauge used: Potable: Non -Potable: 11
Make/Model: Midwest 845-5 SN: 07221418 Date tested for accuracy 7/29/2025
Remarks:
Company Name: DFW Backflow Licensed Tester Name is McMacken
Testing and Repair (PrintT i):
Company Address: 1002 Lost Valley Dr Licensed Tester Name (Signature):
Euless, TX
C
BPOOompany Phone #: 817-239-7423 BPAT License # 14984
License Ex0ration Date: 12/12/2027
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 REPLACEMENT PARTS