201NorthpointDr_75019_53579 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-22421
Test Date: 11/2/2018
Result: Passed
Reason for Test: Existing
Account Name : Staples #4839
Address of Assembly : 201 Northpoint Dr
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 :Conbraco Model No :719 Size :2 Serial No :H06133
Location At:front entrance under bush
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:11/2/2018
Time:10:30 AM
Held at 2.2 psid
Closed Tight
Leaked
Held at 2.6 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: WILKINS Model: TG-5 Serial No.: 03112284
Date Tested for Accuracy: 12/18/2017
Remarks :
Firm Name : Western States Fire Protection Licensed Tester : Jim Renteria
Firm Address : 2345 W.Warrior Trail BPAT License # : BP0014847
Firm Phone No : 214-634-7562 License Expiration Date : 10/04/2021
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.