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Dallas County-LR171025 X N s • c R 7 r , o F COPPELL , r 4 " BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT City: Coppell PWS I,D,:0570040 Address:816 S,Copped Road Copped,Texas 75019 Phone:972-462-5150 Catalog No:TXTC:OP-21.323 Contact Person: Jerry Davis Result: Passed Account Name:Havertys Furniture Address of Assembly: 770 Gateway Blvd. 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:007141 Size:3/4" Serial No:30970 Location At:West Vault Bypass What does this serve? FireLine Is the assembly installed In accordance with manufacturer recommendations and/or local codes?Yes Reduced Pressure Principle Assembly s Pressure Vacuum Breaker Double Check Valve Assembly 1st check 2nd check i .�., Relief Valve Air Inlet Check Valve Held at 1 psid : Held at 1.6 psid psid Opened at psid Opened at Held at psid Closed Tight 0 Closed Tight J Did not open I._l Did not open !-_ Leaked 0 Leaked i Li Leaked Repairs and Materials Used Test Results after Repair 1st check 2nd check ,. Air Inlet Relief Valve Check Valve a,..�.,.. Held at psid Held at psid 0 Closed Tight Closed Tight Opened at psid Opened at psid Held at psid 0 Leaked I 0 Leaked Remarks Test gauge used:Potable Make:Apollo Model:40-200-TK5U Serial No.;019142372 Date Tested for Accuracy: 10/25/2016 The above is certified to be true at the time of testing. Firm name:CEASA FIRE PROTECTION Certified Tester:BILLY PHILLIPS Firm Address:P.O. BOX 104 Certified Tester No.:8P0006724 Exp. Date:07/19/2020 Firm Phone No:214-837-1679 Test Date:9/29/2017 *Test Records must be kept for at least three years. "Use only manufacturer's replacement parts. OD SC 'r 4/1 C K l NG Iii ,i T io N s The following form must be completed for each assembly tested. �-� w� ;OW C P1 LLL * r u e BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT City: Coppell PWS i.D.:0570040 Address: 816 S.Coppell Roan Coppell,Texas 75019 Phone: 972-462-5150 Catalog No:"TxTC0P-21323 Contact Person: Jerry, Davis Result: Pa' cd Account Name:Havertys Furniture Address of Assembly: 770 Gateway Blvd. 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:709DCDA Size: 10" Serial No: 115559 Location At:Vault S.W.corner of property 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 5 psid Held at 4 psid l r 1 Opened at psid Opened at psid Held at psid Closed Tight € 0 Closed Tight s te. +Did not open LI Did not open I I Leaked 0 Leaked '? Leaked Repairs and Materials Used Test Results after Repair 1st check a..... 2nd check Relief Valve Air Inlet Check Valve Held at psid Held at psid 1 Q Closed Tight I 0 Closed Tight Opened at psid I Opened at psid I Held at psid 0 Leaked 0 Leaked Remarks Test gauge used:Potable Make:Apollo Model:40-200-TKSU Serial No. :019142372 Date Tested for Accuracy: 10/25/2016 The above is certified to be true at the time of testing. Firm name:CEASA FIRE PROTECTION Certified Tester:BILLY PHILLIPS Firm Address:P.O. BOX 104 Certified Tester No.:BP0006724 Exp.Date:07/19/2020 Firm Phone No:214-837-1679 Test Date:9/29/2017 *Test Records must be kept for at least three years. **Use only manufacturer's replacement parts. SC ThPACKING SULLITl twl5 AYlrtiHil`AAA 4st*Mass Fb1ia»@ Y" The following form must be completed for each assembly tested. • trP1 e ; C T OP COPPELL * 4 4 I, BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT City:Coppell PWS M1:0570040 Address: 816 S.Coppell Road Coppell,Texas 75019 Phone: 972-462-5150 Catalog No:TXTCOP-21323 Contact Person:Jerry Davis Result: Paced Account Name: Havertys Furniture Address of Assembly: 770 Gateway Blvd. 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:007M1 Size:2" Serial No:396241 Location At:Meter by vault What does this serve? Domestic 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 2 Air Inlet Check Valve Held at 1.4 psid Held at 1.4 psid Opened at psid Opened at psid Held at paid 0 Closed Tight Closed Tight ; 17 I Did not open I ; Did not open ;Leaked 0 Leaked LI Leaked Repairs and Materials Used Test Results after Repair 1st check Y 2nd check _ Relief Valve Air Inlet / Check Valve —T— Held at psid Held at psid 0 Closed Tight a 0 Closed Tight Opened at paid Opened at psid Held at psid 0 Leaked 1 0 Leaked Remarks: Test gauge used:Potable Make:Apollo Model:40-200-TKSU Serial No.:019142372 Date Tested for Accuracy: 10/25/2016 The above is certified to be true at the time of testing. Firm name:CEASA FIRE PROTECTION Certified Tester:BILLY PHILLIPS Firm Address:P.O.BOX 104 Certified Tester No.:6P0006724 Exp.Date:07/19/2020 Firm Phone No:214-837-1679 Test Date:9/29/2017 *Test Records must be kept for at least three years. **Use only manufacturer's replacement parts. SC TRACKING SVLUTIONS $8,0.61`£.».0akor, The following form must be completed for each assembly tested. ... . . . „4 „ . . , COPPELL ▪F s2 9 BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT City:Coppell .... .. _ PWS 1.0.:0570040 Address: 816 S.Coppell Reed Coppell,Texas 75019 Phone:972-462-5150 Catalog No:TXTC;OP-21323 Contact Person:Jerry Davis Result: Passed Account Name:Havertys Furniture Address of Assembly: 770 Gateway Blvd. 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:007M2 Size:3/4" Serial No:36970 Location At:West Vault What does this serve? FireLine Is the assembly Installed in accordance with manufacturer recommendations and/or local codes?Yes Reduced Pressure Principle Assembly 'c, Pressure Vacuum Breaker Double Check Valve Assembly 1st check 12nd check 1 Relief Valve 1Air Inlet Check Valve Held at 1.6 psid I Held at 1.2 psid ~ i Opened at psid Opened at psid Held at psid 0 Closed Tight i 0 Closed Tight r,, Leaked Leaked [ 1_s Did not open Li Did not open !Leaked t Repairs and Materials Used Test Results after Repair 1st check I 2nd check Relief Valve --r ,., Air Inlet _ Check Valve H s Opened at Opened Held at psid Held at psid � 0 Closed Tight i 0 Closed Tight p psid p at psid Held at psid d Leaked i 0 Leaked I , i Remarks: _ _... Test gauge used:Potable Make:Apollo Model:40-200-TKSU Serial No. :019142372 Date Tested for Accuracy: 10/25/2016 The above is certified to be true at the time of testing. Firm name:CEASA FIRE PROTECTION Certified Tester:BILLY PHILLIPS Firm Address:P.O. BOX 104 Certified Tester No.:BP0006724 Exp.Date:07/19/2020 Firm Phone No:214-837-1679 Test Date:9/29/2017 *Test Records must be kept for at least three years. **Use only manufacturer's replacement parts. C TRACKING OL. TIONS JAeaar.pa•h Me.e.W rs f"iet.re' The following form must be completed for each assembly tested. ? KC CITY . 0P COPPELL ge3t4P4 AO% 440317- h BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT City. Coppell PWS I.D.:05/0040 Address: 816 S.Coppell Road Coppell,Texas 75019 Phone: 972-462-5190 Catalog No:Tx-rcop..,) 32-3 Contact Person,Jerry Davis Result: Passed Account Name:Havertys Furniture Address of Assembly: 770 Gateway Blvd. 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 Assembly Frequency:Annual Manufacturer:Watts Model No: 709 Size: 12'' Serial No; 115543 Location At:East 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 5.6 psid Held at 5 psid rat Opened at psid Opened at paid Held at psid Closed Tight •-7-' Closed Tight Did not open Li Did not open ' Leaked 0 Leaked 0 Leaked Repairs and Materials Used Test Results after Repair 1st check 2nd check 1 Relief Valve Air Inlet I Check Valve Held at paid Held at psid O Closed Tight 0 Closed Tight Opened at psid Opened at paid / Held at paid 0 Leaked 0 Leaked . _ Remarks: _• _ _ . Test gauge used:Potable Make:Apollo Model 40-200-TK5U Serial No.:019142372 Date Tested for Accuracy: 10/25/2016 The above is certified to be true at the time of testing. Firm name:CEASA FIRE PROTECTION Certified Tester:BILLY PHILLIPS Firm Address:P.O.BOX 104 Certified Tester No.:BP0006724 Exp.Date:07/19/2020 Firm Phone No:214-837-1679 Test Date:9/29/2017 *Test Records must be kept for at least three years. **Use only manufacturers replacement parts. SC TRACKINt.*' SOLUTIONS Aztv,o ,,t**WS,W4Aria 15,14rtt0 The following form must be completed for each assembly tested. 711C —CITY , OF COPPELL it4 * 04V4*. 4 * * t BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT City:Coppell PWS 1.0 •0570040 Address 816 S.Coppell Road Coppell,Texas 75019 Phone: 972-462-5150 Catalog No: IRTCOP-,!1:323 Contact Person: Jerry Davis Result: Pass en Account Name:Havertys Furniture Address of Assembly: 770 Gateway Blvd. 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:007 Size:3" Serial No:02741 Location At:Showroom Hall What does this serve? Domestic Is the assembly Installed In accordance with manufacturer recommendations and/or local codes?Yes Reduced Pressure Principle Assembly 1 Pressure Vacuum Breaker Double Check Valve Assembly let check 2nd check4 Relief Valve Air Inlet j Check Valve Held at 2 paid Held at 2.2 psid Opened at psid Opened at psid Held at psid Closed Tight 0 Closed Tight ri I rs, L I Did not open I El Did not open J Leaked 0 Leaked 4 N,,A Leaked Repairs and Materials Used Test Results after Repair 1st check 17 2nd check Relief Valve 4, Alt Inlet Check Valve Held at psid Held at psid 1 0 Closed Tight 0 Closed Tight Opened at psid Opened at psid Held at psid 0 Leaked i 0 Leaked Remarks: Test gauge used:Potable Make:Apollo Model:40-200-TK5U Serial No.:019142372 Date Tested for Accuracy: 10/25/2016 The above is certified to be true at the time of testing. Firm name:CEASA FIRE PROTECTION Certified Tester:BILLY PHILLIPS Firm Address:P.O. BOX 104 Certified Tester No.:BP0006724 Exp.Date:07/19/2020 Firm Phone No: 214-837-1679 Test Date:9/29/2017 *Test Records must be kept for at least three years. **Use only manufacturer's replacement parts. SC TRACKING SOLUTIONS .06.4.s...ft Mart,wow* The following form must be completed for each assembly tested. , F-", SC TRACKING SOLUTIONS 14. "Accomplish More, Work Smarter" teceipt technician:BILLY PHILLIPS Invoice : 1127 2017104133536 _ kddress:P.O.BOX 104 Date: 10/4/2017 Aty: WILLS POINT State:TEXAS Zip : 75169 Item Date Catalog No. Description Price Ext.Price Count 10/4/2017 Double Check Valve Assembly Inspection TXTCOP-21323 11.95 1 11.95 1:28:46 PM Serial#: 115543 Result:Passed 10/4/2017 Double Check Valve Inspection TXTCOP-21323 11.95 1 11.95 1:27:50 PM Serial#: 30970 Result:Passed . ., 10/4/2017 Double Check Valve Inspection TXTCOP-21323 11.95 1 11.95 1:27:01 PM Serial#: 02741 Result:Passed 10/4/2017 Double Check Valve TXTCOP-21323 inspection 11.95 1 11.95 1:26:08 PM Serial#:396241 Result:Passed 10/4/2017 Double Check Valve Inspection TXTCOP-21323 11.95 1 11.95 1:25:08 PM Serial#:36970 Result:Passed 10/4/2017 Double Check Valve TXTCOP-21323 Inspection 11.95 1 11.95 1:23:03 PM Serial#: 115559 Result:Passed Sub-Total $71.70 Tax $5.94 Total $77.64 Paid S77.64 Balance $0.00 ipon the completion of an inspection,reports/results are not required to be turned into the city. copy of the report/results will be sent to the designated city representative. 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