1525S_BeltlineRd__75019_51895 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: Failed
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 Assembly Frequency :Annual What does this serve? FireLine
Manufacturer :Watts Model No :774 Size :8" Serial No :111013
Location At:NE Corner 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:10:15 AM
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: 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.Also the #1  shut off will not seal and have to be replaced.The numbers entered above are just place holders,
the device could not be tested because the valves would not seal off.
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.