1525S_BeltlineRd__75019_51891 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-22407
Test Date: 10/8/2018
Result: Passed
Reason for Test: Existing
Account Name : Sarah Hellwig Insurance Agency
Address of Assembly : 1525 S.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 :Double Check Valve Frequency :Annual What does this serve? FireLine
Manufacturer :Watts Model No :007M2QT Size :3/4" Serial No :Unknown
Location At:East Side Vault
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:10/8/2018
Time:10:02 AM
Held at 1.8 psid
Closed Tight
Leaked
Held at 2 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: Apollo Model: 40-200-TK5U Serial No.: 01111188
Date Tested for Accuracy: 1/22/2018
Remarks :This vault stays full of water.An automatic pump should be installed to prevent any further degradation of the backflows
installed.
Firm Name : Action Fire Pros Licensed Tester : Wesley Higgs
Firm Address : 3709 S I-35 E BPAT License # : BP0014258
Firm Phone No : 800-550-2287 License Expiration Date : 11/30/2020
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.