1501E_BeltlineRd__75019_41723 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: 3/28/2018
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 :Watts Model No :909 Size :2 1/2 Serial No :116072
Location At:Mechanical Room domestic supply
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:3/28/2018
Time:10:24 AM
Held at 8.2 psid
Closed Tight
Leaked
Held at 8 psid
Closed Tight
Leaked
Opened at 3.2 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: Conbraco Model: TG5 Serial No.: 08101659
Date Tested for Accuracy: 1/23/2018
Remarks :Replaced #1 and #2 check valve discs,replaced #2 check valve seat
Firm Name : Bishop Backflow Service,Inc.Licensed Tester : Steve Bishop
Firm Address : P.O.Box 293641 BPAT License # : BP0003704
Firm Phone No : 214-675-9983 License Expiration Date : 05/01/2020
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.