HomeMy WebLinkAboutMF2016-3121 Texas Commission on Environmental Quality
Customer Service Inspection Certificate
Name of PWS: Cit of Grapevine
PWS ID #: 2200 113
Location of Service: I A S BLUFFS l 1 —/
Reason for Inspection: New construction ...... ................ ................................... .................. ❑
Existing service where contaminant hazards are suspected.......,.... ❑
Major renovation or expansion of distribution facilities..................... ❑
upon inspection of the private water distribution facilities
connected o the aforep6entioned public water supply do hereby certify that, to the best of my
knowledge:
Compliance Non-Compliance
(1) 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
C� ❑ 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 backflow
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
dl ❑ labeling indicating 5025% lead content. If not properly labeled,
T 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.
1 further certify that the following materials were used in the installation of the private water distribution facilities:
Service lines; Lead ❑ Copper PVC A Other ❑
Solder; Lead ❑ Lead Free 2 Solvent Weld Other ❑
1 recognize that this document shall become a permanent record of the aforementioned Public Water System and
that I am legally responsible for the validity of the information I have provided,
Remarks: I Existing plumbing may have been installed without permits/ inspections and therefore cannot be verified.
It is impossible to verify compliance of existing plumbing which is covered by building construction.
Signature of Inspect o License Number: =-300
Title: ins ec Type of License: Plumbing Inspector
Date:
0'fcrms\TCEO-ZD699\04-17 17