Sandy Lake Med-CS040720 MEMORANDUM
FROM THE
DEPARTMENT OF PUBLIC WORKS
CITY OF COPPELL
DATE:
TO:
FROM:
RE:
July 20, 2004
Garreth Campbell, Engineering
Danny Hightower, Utilities
Sandy Lake Medical Plaza Punch List from Walk-thru 7/20/04
1. 't~ark FHV in red on curb and paint lid on valve stack (on Moore Rd.).
2. ~Need pad on valve to vault.
3. ~/Need blocking in vault under wheel valves.
4. ? Lock on FDC; check with Fire Dept.
5. c--Paperwork on all DC's tested.
6. ~ Raise fire hydrant on Moore Road; City fire hydrant.
7. ~" Raise valve on City fire hydrant on Moore Road with pad.
8. ,,'- Cheek domestic DC on follow-up; lid will not open.
9. t-~lblark MH in red on curb at manhole.
Please contact my office at 972-462-5150 to schedule a follow-up walktb_ru on the punch list
items.
C}tECK ONE:
IRRIGATION
DOMESTIC FI_RELINE
NAME OF PWS:
PWS LD. #
LOCATION OF SERVICE:
The backflow prevention assembly detailed below has been tested and maintained as required by TCEQ
regulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
Redu~l l~ss~e Principle
Check Valve
Vacuum
Am~-pherc Vacuum
l',t e+er'
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double Check Valve Asst~My
1st Check 2nd Check Relief Valve Air Inlet Ch~.~.k Valve
Initial TestDC-Cles~l 'Cles~l Tight ~/ Opened at Opened at psid
Ti~u ~ Leak~ a psid psid
Leaked = DidnotOpen ~ Leaked
Mam'ials
Use~
Te~t After DC-Closed Cloud Ti~t c~ Opened at Opened at psid
Repair Tight = psid psid
Date last accuracy tested
White - Customer~ Cogy Yellow - City Copy Pink - Tester*s Copy
CHECK ONE:
IRRIGATION
DOMESTIC
BACIO'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
PWS LD. #
LOCATION OF SERVICE:
/
The backflow prevention assembly detailed below has been tested and maintained as required by TCEQ
regulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
; REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACLrOM BRF..AKE~
Double Check Valve A.~.mhly
l~t Check J 2nd Check Relief Vslve Air Inlet Ch~rk Valve
Initial Test DC-Closed Closed Tight a/
/ Ope~d at Opened at psid
Tight
Leak~ t-,psid psid
RP- psid
~ O Did not Open r~~ r~
Used
TestA.q~ DC-Closed CL_,~_~Tight O Openedat Op~medat psid
R~air Tight ~ psid vsid
RP psid
D~te lest ~ccur~c~ tested 15 -~* 0 ~
White - Customer's Copy Yellow - City Copy Pink - TesteFs Copy
CHECK ~NE:
I~RIGATION DOMESTIC PIRELINE /
PWS I.D. #
LOCATION OF SERVICE:
!
The backflow prevention assembly detailed below has been tested and maintained as required by TCEQ
regulations and is certified to be operating within acceptable parameters.
TYPE OF ASSEMBLY
Pressure Vacumn BreaSt
Atmosphere Vacuum
<3"
REDUCED PRESSI~ PRINCIPLE ASSEMBLY PRESSURE VACI~ BREAI~R
Double C~eck V~lve Ass-~hly
1st Check 2nd Check Relief Vnive Air Inlet Ch~k Vnlve
Ini~al Te~'tDC-Clo~ / Closed Ti~h~ d ~ at OWn~ ,£ I:mi4
Tight ~ [] psid psid
KP. psid
Leak~l O Did not Open
Mat=iais
Used
TestAft= DC-Closed Closed Tight oOpenedat Openedat psid
R~pair Ti~t o psid psid
RP___..._p~d
Fim~A~Mm~ L~u~, ~V,~l,~,-q--F-. V~J~CcrLTcstcrN~
Date last accuracy tested
White - Customer's Copy
Yellow - City Copy
Pink- Tuster~ C~py
CtI~iCK ONE:
IRRIGATION
DOMESTIC PIRELINE
BACIO~X)W PRE¥1~ITION A..~qF. MBLY TEST AND MAII~'ENANC~ REPORT
~ ~euble ~Chcck Valve
Model Nmnber
S~"ial Number
TYPE OF A~SEMBLY
Pr~mre Vacuum B _r~t~
A~mosphere Vacuum
Located At
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
Double Check Valve Assembly
1st Check [ 2nd C~eck Relief Vnlve Air Inlet Check Valve
Initial Test DC-Closed /, ~_ Closed Ti~h~'~. Opened at Opened a~ psid
Ti~t /n~ Leak~ O psid psid
RP-...~psid
Leaked ~ DidnotOpen o L~aked []
Ma~ials
Used
Test ~ DC-Closed Closed Tight o Opened at Opened at ~d
R~pair Tight o psid psid
Date last ,ccurae, tested :'./~/Q~
White - Customers Copy Yellow - City Copy Pink - Tester~ Cogy
CHkCK
IRRIGATION DOMEffrIC ¢/
F/REL/NE
Manufacturer
Model Number
Sa'iai Number
TYPE OF ASSEMBLY
[] Pr~r~ Vactmm Br~k~r
~ Almosplzre Vacuum Br~b~-
Siz~ ~'
3.
REDUCED PRESSIiqJ/PRINCIPLE ASSEMBLY PRESSURE VAO.,q.,rM BREAKER
Double ~ V~ve ~ly
1~ ~ [ ~d ~ ~d V~e Mr IM~ ~ V~e
~fi~ T~ DC~I~ ~ Cl~ Ti~ ~ .
Ti~ ~ ~ o ~sid ~a
~L~sid ~sid
~ O , ~d hoc ~ ~ ~ 0
U~
T~ ~I~ CI~Ti~ 0 ~a ~
' ~ ~id psid
Gauge # , Q,--~ ~: .}-/:~
Date last accuracy tested
White - Customer~ Copy Yellow - City Copy Pink - Tester~ Copy
COFFELL
Department of Public Works
Initial Date: August 04, 2004
Final Date:
Created By: Michael Corder
Water
Name
Address
Cross Street
Location
Description
WOWA-04-2721
C F Jordan
546 E Sandy Lake
Easement
Walk Through
(H) ~] Left Door Knocker
(W) ~ Spoke to Resident
[~ Called Resident
Notify Water Billing
Follow up walk thru for Coppell Health. Contractor said punch list was completed.
Office Comments
Assigned To
Danny Hightower
Old Meter #
Reading
New Meter #
Reading
Personnel Assigned Hours Quantity
Field Comments: ~ .~ ~N~c~g (~,q~'~:4~
Parts - Equipment Used
Signature: /r/~-~ '-' Date: ~PT~ '-/'~;~ Time: ~-' ~'~-x~7
P,O, Box 9478 - 8t6 S. Coppell Rd - Coppell, TX 75019 - Phone (972) 462-~t~0 - Fax (972) 462-5t$S