225ESH121Suite120_75019_59623 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-22362
Test Date: 11/26/2018
Result: Passed
Reason for Test: Existing
Account Name : Holmes Builders
Address of Assembly : 225 E SH 121 Suite 120
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? Domestic
Manufacturer :Wilkins Model No :975 Size :3/4 Serial No :3487956
Location At:water heater closet ste 100
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:11/26/2018
Time:12:10 PM
Held at 8.4 psid
Closed Tight
Leaked
Held at 8 psid
Closed Tight
Leaked
Opened at 3.2 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.: 06110069
Date Tested for Accuracy: 7/24/2018
Remarks :
Firm Name : All Test Service Solutions Licensed Tester : Kolton Hodges
Firm Address : 600 Henrietta Creek Rd.#100 BPAT License # : BP0017955
Firm Phone No : 817-379-0856 License Expiration Date : 07/06/2020
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.