343OxfordPlace_75019_67979 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-43724
Test Date: 4/12/2019
Result: Passed
Reason for Test: New
Account Name : Current Water Customer
Address of Assembly : 343 Oxford Place
Address Type : Residential
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 :Only on Installation What does this serve? Irrigation
Manufacturer :Wilkins Model No :350 Size :1 Serial No :A808647
Location At:Along curb by meter
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:4/12/2019
Time:1:00 PM
Held at 1.6 psid
Closed Tight
Leaked
Held at 1.6 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: MacArthur Model: 844 Serial No.: 10021520
Date Tested for Accuracy: 10/3/2018
Remarks :
Firm Name : A &A Active Backflow Licensed Tester : John Ansley
Firm Address : 1611 N IH 35E BPAT License # : BP0006162
Firm Phone No : (972)242-2229 License Expiration Date : 04/04/2020
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.