110WSandyLakeRd_75009_47687 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-37628
Test Date: 7/26/2018
Result: Passed
Reason for Test: Existing
Account Name : Woodside Village
Address of Assembly : 110 W Sandy Lake 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 :Double Check Valve Frequency :Annual What does this serve? Irrigation
Manufacturer :Febco Model No :850 Size :2 Serial No :H48572
Location At:front at meter for whole bldg
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:7/26/2018
Time:3:00 PM
Held at 3.1 psid
Closed Tight
Leaked
Held at 2.5 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: 845-5-0011 Serial No.: 09090728
Date Tested for Accuracy: 9/13/2017
Remarks :
Firm Name : Avalon Licensed Tester : Douglas Richie
Firm Address : 901 S Cedar Hill Rd.BPAT License # : BP0012593
Firm Phone No : 469-258-7720 License Expiration Date : 10/28/2018
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.