253ClubCircleDr_75019_33181 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-21299
Result: Passed
Account Name : Estates of Coppell
Address of Assembly : 253 Club Circle Dr
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 :unknown Model No :unknown Size :1 Serial No :unknown
Location At:MacArthur Blvd between Independence &Colonial
What does this serve? Irrigation
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 2.1 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 :Wilkins 950XLT SN 383462
Test gauge used : Potable
Make : Longhorn Model : 845-3-0006 Serial No. : 04050499 Date Tested for Accuracy : 9/22/2017
The above is certified to be true at the time of testing.
Firm name : North Texas Backflow Certified Tester : John Davis
Firm Address : P.O.Box 597 Certified Tester No. : BP0003132 Exp.Date : 06/12/2020
Firm Phone No : 469-231-6623 Test Date : 10/9/2017
*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.