1315RiverchaseDrive_75019_35244 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-22140
Result: Passed
Account Name : The Club At Riverchase
Address of Assembly : 1315 Riverchase Drive
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 :1 1/2" Serial No :613703
Location At:Riser Room Bld 5
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 2.3 psid
Closed Tight
Leaked
Held at 2.7 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 : Mid West Model : 845-5 Serial No. : 02151271 Date Tested for Accuracy : 1/25/2017
The above is certified to be true at the time of testing.
Firm name : Metro Communication Systems Certified Tester : Gilbert Morgan
Firm Address : P.O.Box 1267 Certified Tester No. : BP0015991 Exp.Date : 09/30/2020
Firm Phone No : 972.621.8700 Test Date : 10/30/2017
*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.