1501E_BeltlineRd__75019_35545 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-22339
Result: Passed
Account Name : Valley Ranch Baptist Church
Address of Assembly : 1501 E.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 :Hersey Model No :FDC Size :3/4 Serial No :166339
Location At:N.W.Vault Fireline Bypass
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 :
Test gauge used : Potable
Make : Conbraco Model : TG5 Serial No. : 08101659 Date Tested for Accuracy : 1/25/2017
The above is certified to be true at the time of testing.
Firm name : Bishop Backflow Service,Inc.Certified Tester : Steve Bishop
Firm Address : P.O.Box 293641 Certified Tester No. : BP0003704 Exp.Date : 05/01/2020
Firm Phone No : 214-675-9983 Test Date : 11/6/2017
*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.