444BurnsSt_75019_36541 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-28674
Result: Passed
Account Name : Current Water Customer
Address of Assembly : 444 Burns St
Address Type : Residential
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 :Only on Installation
Manufacturer :Wilkins Model No :350DA Size :1 Serial No :A683353
Location At:Front Yard
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 2.2 psid
Closed Tight
Leaked
Held at 2.2 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 : Apollo Model : 40200TK5U Serial No. : 03100664 Date Tested for Accuracy : 5/4/2017
The above is certified to be true at the time of testing.
Firm name : Lakeside Irrigation Certified Tester : John Travis
Firm Address : 504 Willow Springs Certified Tester No. : BP0014792 Exp.Date : 09/21/2018
Firm Phone No : 972-722-8020 Test Date : 12/4/2017
*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.