1501E_BeltlineRd__75019_41707 BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
Name of PWS: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
Test Date: 3/27/2018
Result: Passed
Reason for Test: Existing
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 :Reduced Pressure Principle Frequency :Annual What does this serve? Domestic
Manufacturer :Wilkins Model No :975 Size :2 Serial No :W096193
Location At:In ceiling for N.canopy hallway inside front door
Is the assembly installed in accordance with manufacturer recommendations and/or local codes?Yes
Is the assembly installed on a non-potable water supply (auxiliary)?No
Reduced Pressure Principle Assembly Pressure Vacuum Breaker
Spilled-Resistant Vacuum BreakerDoubleCheckValveAssembly
1st check 2nd check Relief Valve Air Inlet Check Valve
Initial Test
Date:3/27/2018
Time:8:00 AM
Held at 7.8 psid
Closed Tight
Leaked
Held at 7.6 psid
Closed Tight
Leaked
Opened at 2 psid
Did not open
Opened at psid
Did it fully open
Yes No
Held at psid
Leaked
Repairs and Materials
Used **
Test After Repair
Date:
Time:
Held at psid
Closed Tight
Leaked
Held at psid
Closed Tight
Leaked
Opened at psid Opened at psid Held at psid
***2nd check:numeric reading required for DCVA only
Test gauge used: Potable Make: Mid West Model: 845-5 Serial No.: 07172120
Date Tested for Accuracy: 9/21/2017
Remarks :
Firm Name : Northstar Fire Protection Licensed Tester : Henry Pios
Firm Address : 510 East Corporate Drive Suite 700 BPAT License # : BP0013269
Firm Phone No : 469-635-4400 License Expiration Date : 08/18/2019
The above is certified to be true at the time of testing.
* Test Records must be kept for at least three years.[30 TAC §290.46(B)]
** Use only manufacturer's replacement parts.