1717E_BeltLineRd__75019_46186 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-22404
Test Date: 6/29/2018
Result: Failed
Reason for Test: Existing
Account Name : St.Marin Apartments
Address of Assembly : 1717 E.Belt Line 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? FireLine
Manufacturer :Watts Model No :009M2 Size :2 Serial No :120861
Location At:Bldg.6 Fire Closet
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:6/29/2018
Time:8:00 AM
Held at 10 psid
Closed Tight
Leaked
Held at 9.7 psid
Closed Tight
Leaked
Opened at 3 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: MacArthur G Model: 844-0005 Serial No.: 351582
Date Tested for Accuracy: 4/16/2018
Remarks :Both checks and relief valve were replaced.
Firm Name : Elevation Lawn Care LLC Licensed Tester : Joshua Gilbreath
Firm Address : 9305 Toledo Bend BPAT License # : BP0016114
Firm Phone No : 940-765-3221 License Expiration Date : 09/10/2020
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.