2014_0502 CITY OF COPPELL W.ATER UTILITIES
� CUSTOMER SERVICE�NSPECTIOl�
Residential
Commercial ❑
� / TNRCC ID#057A040
� h��,� � , ,J
� ,upon inspection of the private water distribution facilities located at
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. >which is connected to the City of Coppell Water 5ystem, do hereby certify
that, to the best of my knowledge:
In Non- N/A
(1) No direct connection between the public drinking v�ater supp]y and a potential Complia ce� Compliance
source of contairiination exists, Potential sources of contamination are isolated � �
from the public water system by an air gap or an a ro nate backflow prevention ❑
assembly in accordance with Commission reguIati ns, p
(2) No cross-connection between the public drinking water supp(y and a pr�vate water
system exists. Where an actual air gap is not maintained be t w e e n t h e p u b l i c wa ter � � �
s u p p I y a n d priva te water supply, an approved'reduced pressure-zone backflow
prevenfion assembly is properly installed and a service agreement exists for
annual inspection and testing by a certified backflow prevention device tester.
(3) No connecrion exists which would allow the retum of water used for condensing �
cooling or indus�ial processes back to the public water supply. � ❑
i
(4) No pipe or pipe fitting whicb contains more than 8.0%lead exists in private water �
dis�ibution facilities installed on or after July 1, 1988. ❑ ❑
(5) No solder or flux which contains more than 0.2% lead exists in private water p� , ��
distribution facilities installed on ar after July 1, 1988. 17 ❑
Water service shall not be provided or restored to the private water disfibution faciIities unti]the above condirions are determin
in compliance.
ed to be
I certify that the following materials will be used in the installation of the private water disti-iburion facilities located a �
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and that the inspector will validate compliance during the inspecrion process:
Service lu�-� Lead ❑ �
Solder Lead p Copper ❑ PVC Other p
Lead Free ❑ Solvent Weld� p� �
Other ❑
I recognize docume shall become a permanent record of the aforementioned Public Water System and that I am le
responsi f validi f the information I have provided.
gally
Si re o ice Plumber • _ �—.3 07�� � �
Registration Number
Type of Registration �'� �'" o���Y
Date
I recognize that this document shall become a permanent record of the aforementioned Public Water System and that I am le all
responsible for the validity of the infomnation provided.
g Y
Signature of Inspector
Registration Ntunber
Type of Registration �
Date
�i«-Customefs Copy .
Yellow•Citys Copy
pink-�aspedors Copy