2017_0316 CHBCK ON&
IRRIGATION DOMBSTIC FIRBLINE`�
BACI�'LOW PREVENTION ASSEIV�LY TEST AND A�LAINTENANCE REFORT
NAME OF Pw5: CITY OF COPPELL
PWS LD.# Valley Ranch Baptist Church
j,�A'rjQrj QF$��CE: 1501 E Beltline Rd Coppeli 75109
�C bsC�OW pIZVCdLOII a43Cmb� dGt811Ed �OW �S �lSD �tS� 8� � 3S ICq0l1+Cd b'V �RCC
rognlations aad is certi5od tfl be opaatiag witl�in acceptabk paramcters.
TYPE OF ASSEMBLY
❑ Reduced Pn�ssiue Priaciple e Pressure Vacuian Brealodr
t� Double CHecic Valve o Am�osphae Vacuum Bsealc�r
g„
Maaufac�aer 5iu
Madel Niaaber 171��L Located At 2,� �/�I�it�/6./��-.a..� I
s«�x�� 9�033�1 � �
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUiTM BREAI�R i
Doubie C�elc V alve Assembfy I
lst C3eck 2nd CLecic Relief Valve Air ldet Cbeck Va1ve
i
Initial Test DC-Closod Closod Tight o Opeaed at � Opeaed at �id
Ti�ht ❑ Lealcod �( _nsid �psid
RP-_psid
Leaked � Did not Opea O Leaked D
Repaas I
and �
Materiata j
� U� � `� ' /t,� � 1� �f� r� r��'v a�cc_ �
�
Tat ARer DC-Closed Closed Tight o Opened at ppmad at � j
Repair Tight o _psid osid �
� �
Tbe above ia catified to be tnu. �
i
F�rj� 1-A Fire&Domestic Testihq C�{�T� Jeremy Richards , i
, i
Fj��PO Box 79548 Fort Worth Texas 76179 Cert.Testc No. BP0011462 �� -�`!7
Gavge � 0073178
Date last accuracy tested 12/2/16
White-Customer's CopY Yellow-City CopY Pink-Tester's CopY
I
CHBCK ONB:
IIiBIGATION DOMBSTIC FIRBLINB� ✓
BAC[�LOW PREVENTION AS5EIV�LY TEST AND MAINTENANCE REPORT
NAME OF PWS: C77'Y OF COPPELL
PWS I.D.# Valley Ranch Baptist Church
LOCATION OF SERVICE: 1501 E Beltline Rd Coppell 75109
The bacL-�low pcevention a4sembly daailod bdow Has beea testod aad maiataiaed as nquirod by TNRCC
regnlations aod is certified to be operariag withia acceptabk para�esers.
TYPE OF ASSEMBLY
c Reduced Prossure Priacipie e Presssure Vac�naa Breaker
❑ Da�ble Chock Valve ❑ Am�osphee V�Breaker
Manuf'act�aer __1� �o size ���-1"
Modei Number TDC Located At /�!✓, /n�.w� 2.. ✓a.,l� . i
' i
seriat xumber IGG�3�t ' !
I
REDUCED PRE55URE PRINCIPLE ASSEMBLY PRESSURE VAC[Ji7bt BREAKER I
�
Double CbecJc�alve Assembly
i
lst C3eck 2nd Check Relief Valve Air Ydet ChecJc Vafre
Iaidal Test DC-Ctosed Closed Tight o ppened at , ppeaed at �id I
Tight a Leal►od � __nsid �sid
R.P•�sid
I.eai;ed Did aot Open o Leaiced O I
RePaas
aad
Macaials
' Uaed ;
a
Test ABet DC-Closed Closed Tight o OpeQe�at pp�� _�____�� j
Rtp�ir Tight o __��sid �_�osid i
RP
The sbove ia catified w be orue. !
i
Fy�N� 1-A Fire&Domestic Testihq �T� Jeremy Richards . i
, i
F'1lal�PO Box 79548 Fort Worth Texas 76179 Cert TestcNo. BP0011462 � ���L�/7
��
Ga�e � 0073178 ��
Date last accuracy tested 12/2/16
White-Customer's Copy Yellow -Cit3► CaPY Pink-Te�ter's Copy
i
CHBCK ONB:
IRBIGATION DOM88TIC FIRELINB� ✓
BACI4'LOW PREVENTION A5SEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: C'I�'OF COPPELL
PWS I.D.# Valley Ranch Baptist Church
L,QCA'�Qj�j QF$��CE: 1501 E Beitiine Rd Coppell 75109
�1C baC�OW ptCVQibC� �SSC�� dGfat�Cd �OVV �S bECII tCSiOd 8IId II�IaLffiIIC� 3T IC�13iil+� b�► �RCC
1C�C�5�IS C�Q'�Od fA bC OpCCB�II$W1t111C BCCC`pt8b�C p�CtGSS.
?YPE OF ASSEMBLY
❑ Reducxd Pressure Priaciple e Prtssure Vacu�Brealoer
❑ D�ble Choe(c Valve ❑ Atmosphere Vacuum Braalcer
M� �,/k,;,s s� �"
Model N�ber `7 7`� Located At �• Ca� o,�ea i
� T- � i
Serial N�mmba �+.�Dc14 /8� I
i
i
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V 4CUiJM BRF.AI�R �
I
Doubie C6eelt Va1ve Assembly i
lst Cbeck 2nd Cbeck Rdief Valve Air Inlet C�eck Vah►e
laidal Test DC-Closod Closed Ti I
al 8ht � Opeaed at • Opened at _psid i
Tight � Leal:cd � � sid �sid �
�• �� � 7.Z
Leal:ed 0 Did not Opea D Leaked D
RePans
and
Matsriala �
' Uaad
rac� nc-c�a ci�a r,�c o o�a�c o�a�c �;d i
.�"- i
tt��r r��c o �ua .�S�a i
� �
?he sbove ia certified to be teve. I
i
Fitm Name_ 1-A Fire&Domestic Testihq C�{�T� Jeremy Richard , i
, i
F'nm Addraa Po aox�ssaa Fort wortn Te��s��s Cerc,Testa No. _BP0011462 �� cg'J�.-l7
-
Gau�e # 0073178
�_
Date]sst accuracy tested 12/2/16
White-Customer's Copy Yellow-City CopY Pink-Tester�s Capy
i
CHSCK UN&
IRRIGATION ✓ DOMBSTIC FIRBLINB�
BAC�'LOW PREVENTION ASSEMBLY TEST AND MAIIVT'ENANC�REPORT
NAI�OF PWS: C17'�'OF COP�ELL
PWS I.D.� Valley Ranch Baptist Church
I„QCA'rjQrJ QF$��C$: 1501 E Beltline Rd Coppell 75109
�IbC �OW pILVCRhOII �4SG�b� dGLBl�Cd �OVV �S �CC[i tCSi� 8� mffiIILaIII� aS � }JV TNRCC
?C�i]�8t10nS ffid lE C�'�i�Ld 1A tfC�W11�13II BCCCptSb�C pai�iCtaS.
TYPE OF ASSEMBLY
❑ Reduced Pnssure Priaciple c Pressure V�Bnaicer
� Double Cbxk Vatve D Amiosphae Vacuum Breaker
Manufactuu�eer [� k�-l: S;ze _ �"
Mod�el Number ��rvt� Located At /v S��G G�J�ib� , I
' i
S«ial N�mmi�eer �3q c� ' �
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BRF.AI�R ,
Doubie C�eic V alve Assembip
lst Check 2nd C�1c Rdief valve Air Iniet Checic Vsive I
Initial?est DC-Closed Closai TiBht �" Opeaod at • Opeaed at I
Tight R4. Lealccd O __osid �sid ��
RP-,�psid
L.ea�:od � �.Y Did aoc Open o Leaiced p
RePaas
and
Macaisla
' U�j d
Te�t ARer DC-Closed Closed Tight o pp�� p�� �� �
Rep�it Tight O _Tnsid __�osid I
RP d f
The sbove is cttified to be orue. I
�
Fitm Name_ 1-A Fire& Domestic Testihq �_� Jeremy Richards , i
, i
Fita!A�CS�PO Box 79548 Fort Worth Te�as 76179 Cert.Teata No. BP0011462 �� �!G��7
Ga�e � 0073178
Date last accuracy tested 12/2/16
White-Customer's Copy Yellow-City CopY Pink-Tester�s Ccpy
i
C�IBCK ONB:
IR$IGATION DOMESTIC FIRBLINE� �./
B�c�,ow r�vExriox�ss�sLY rEsr�rm rs�wvrEx�►ivcE�oRr
NAI�OF PWS: C'I�'OF COPPELL
PWS LD.�k Valley Ranch Baptist Church
LOCATION OF SF,RVICE: 1sQ� E Beit��ne Ra copPen �sios
1�ie bacLflow prevendon assembly detailed bdow has boaa tate� aad maintaiaed as requirad by TNRCC
ngulatio�s and is certified to b�operadag witl�in a�cceptabk parametGrs.
TYPE OF ASSEMBLY
c Reduad Pnssure Priaciple c Pressur�Vacuian Brealcer
.e" Double Chxk Vatve ❑ Atmosphce Vacuum Breaker
Manuf'act�a�er 1�..�.�S Siu _ �"
Modei N�ber —1'�,�-1�C Located At I(�� Co�n,� �n 1�w,,,�/� I
Scial Number i bc���1�
REDUCED PRESSZJRE PRINCIPLE ASSEMBLY PRESSURE V�CUt?M BREAKER
Doubic C�ck Valve Assembly �
lst Check 2nd C3ec1c Rdief Valve Air Ialet Check Va1ve i
i
Iainal Test DC-Closed Closed Ti$ht �f npeaed at � Op�aed ac _psid �
RP-��•� �d � Leaf.od o __�sid _� d �
Leal:ed o a.� Did aoc Open o Leakod p I
RePafrs
and
Materiats �
' Uaed
Tat ARer DC-Closed Closed Tigbt o Op��� pp�� �
Repair Tight o __nsid __,osid �� I
R.P � I
Tbe above ia c;erti6ed to be anu. I
�
g�N� 1-A Fire&Domestic Testihq ��T� Jeremy Richards , i
, i
F'1in1�[�f PO Box 79548 Fort Worth Texas 76179 C�rt.Tssta No. _BP0011462 j���C.��/7
Gaug�e � 0073178
Date lest accuracy tested 12/2/16
White-Customer's CopY Yellow-City CopY Pink-Tester�s Ccpy
i
C�ISCK ONB:
IRBIGATION DOMBSTIC FIRBLiNB� ✓
BACIQ+'LQW PREVEIVTION ASSEMBLY TEST AND 11L�lII�Ti'�NANCE REPORT
NAIME OF PW5: CITY OF COPPELL
PWS LD.# Valley Ranch Baptist Church
L,�A'I'jOrj�F'S��CE: 1501 E Beitline Rd Coppell 75109
�C b�OW pIZVCptLOII aSSCmb� dGiB{lOd �OVP �5 vCGa � � ID�I�L�III� 3S t!QlIIILd bV �RCC
reguladons and is certified to be opaatiag withia accxptabk para�netas.
TYPE OF ASSENIBLY
e Reduad Pressure Principle e Pressure Vaanaa Br�lCer
,e' Doui�le Chxk Valve a Atmosphere Vacuum Breaker
�� 1,,la, s� 3/�"
Model N�ber Gb'1 rv�1 Located At /(�� �a�i�..� �,�, ✓.lita . I
s«��x,�� 50�� ..
i
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACtTUM BREAKER
Doubie C3etlt Valve Assembly (
lst C3eck 2nd ChecJ: Relief Valve Air ldet G�eck Val�ne
Iniaal?est DC-Closed Closod Tight � Opeaed at • Opeaed at �gaid
Ti�t �l Leal:od a _,,,,.nsid '_nsid
RP• �'�id
Leaked p t.�l Did not Open o Lasiced O
R�Paus
aad
Materiala j
' Uaed �
;�
Test AB�et DC-Closed Closod Tig6t o pp��� pp�� n:id I
Rep�ir Tight o _psid osid �� '
R.P i
i
The above is catified to be orue. �
i
gj�N� 1-A Fire&Domestic Testihq C��T� Jeremy Richards , i
, i
FIl1n A�PO Box 79548 Fort Worth Texas 76179 Cat Testa No. BP0011462 j��_—/7
Ga�e � 0073178
Date last accuracy tested 12/2/16
NThite-Customer's CopY Yellow -City CopY Puilc-T�teNs Copy
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