1501E_BeltlineRd__75019_68307 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-22339
Test Date: 4/8/2019
Result: Passed
Reason for Test: Existing
Account Name : Valley Ranch Baptist Church
Address of Assembly : 1501 E.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 :Hersey Model No :FDC Size :3/4 Serial No :116339
Location At:N.W.Vault Fireline Bypass
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:4/8/2019
Time:8:30 AM
Held at 2 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: Mid-West Model: 845 Serial No.: 06142853
Date Tested for Accuracy: 9/4/2018
Remarks :
Firm Name : Allied Fire Protection Licensed Tester : LARRY WORLOW
Firm Address : 3361 Boyington Dr BPAT License # : BP0010000
Firm Phone No : 972-840-1700 License Expiration Date : 02/28/2022
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.