1201ESandyLake_75019_42367 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-22045
Test Date: 4/13/2018
Result: Failed
Reason for Test: Existing
Account Name : St Joseph Village
Address of Assembly : 1201 E Sandy Lake
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 What does this serve? Irrigation
Manufacturer :Febco Model No :850 Size :2 Serial No :H24188
Location At:East of Property,on Starleaf Street,outside fen
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:4/13/2018
Time:3:30 PM
Held at 0 psid
Closed Tight
Leaked
Held at 0 psid
Closed Tight
Leaked
Opened at 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: MidWest Model: 845-5 Serial No.: 09111436
Date Tested for Accuracy: 3/9/2018
Remarks :Could not complete test due to corroded #2 shut off valve unable to fully close.
Firm Name : Double D Fire Inc.Licensed Tester : Hugh Dennis
Firm Address : P.O.Box 2695 BPAT License # : BP0017925
Firm Phone No : (972)564-0564 License Expiration Date : 02/14/2021
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.