1525S_BeltlineRd__75019_34705 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-22407
Result: Passed
Account Name : Sarah Hellwig Insurance Agency
Address of Assembly : 1525 S.Beltline Rd.
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 :Watts Model No :007M2QT Size :3/4" Serial No :Unknown
Location At:East Side Vault
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 1.8 psid
Closed Tight
Leaked
Held at 2 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 :This is the fireline bypass.
Test gauge used : Potable
Make : Apollo Model : 40-200-TK5U Serial No. : 01111188 Date Tested for Accuracy : 2/21/2017
The above is certified to be true at the time of testing.
Firm name : Action Fire Pros.Certified Tester : Wesley Higgs
Firm Address : 3709 S IH 35 E Certified Tester No. : BP0014258 Exp.Date : 11/30/2017
Firm Phone No : 214-549-7793 Test Date : 10/21/2017
*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.