1555SandyLake_75019_30746 BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
City:Coppell
PWS I.D.:0570040
Address:816 S.Coppell Road
Coppell,Texas 75019
Phone:972-462-5150
Contact Person:Jerry Davis
Catalog No: TXTCOP-22042
Result: Passed
Account Name : Riverchase Montessori
Address of Assembly : 1555 Sandy Lake
Address Type : Commercial
Inspection
The backflow prevention assembly detailed below has been tested as required by TCEQ regulations and is certified to be
operating within acceptable parameters.
Type of Assembly :Double Check Valve Frequency :Annual
Manufacturer :Wilkins Model No :950 Size :3/4 Serial No :3529502
Location At:vault in front
What does this serve? FireLine
Is the assembly installed in accordance with manufacturer recommendations and/or local codes?Yes
Reduced Pressure Principle Assembly Pressure Vacuum Breaker
Double Check Valve Assembly
1st check 2nd check Relief Valve Air Inlet Check Valve
Held at 2.2 psid
Closed Tight
Leaked
Held at 1.9 psid
Closed Tight
Leaked
Opened at psid
Did not open
Opened at psid
Did not open
Held at psid
Leaked
Repairs and Materials Used
Test Results after Repair
1st check 2nd check Relief Valve Air Inlet Check Valve
Held at psid
Closed Tight
Leaked
Held at psid
Closed Tight
Leaked
Opened at psid Opened at psid Held at psid
Remarks :
Test gauge used : Potable
Make : Midwest Model : 835 Serial No. : 10071103 Date Tested for Accuracy : 11/9/2016
The above is certified to be true at the time of testing.
Firm name : Cantu Fire Protection Certified Tester : Daniel Cantu
Firm Address : 1605 East Park Blvd.Certified Tester No. : BP0009580 Exp.Date : 02/28/2018
Firm Phone No : 214-554-3105 Test Date : 9/1/2017
*Test Records must be kept for at least three years.
**Use only manufacturer's replacement parts.
The following form must be completed for each assembly tested.