620N_CoppellRd__75019_42469 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-22466
Test Date: 4/18/2018
Result: Passed
Reason for Test: Existing
Account Name : Regency By The Lake
Address of Assembly : 620 N.Coppell 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 :Ames Model No :200B Size :2 Serial No :0000292
Location At:Riser room building #26
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:4/18/2018
Time:3:30 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 **replaced 3 test ports
Test After Repair
Date:4/18/2018
Time:3:45 PM
Held at 2.4 psid
Closed Tight
Leaked
Held at 2.4 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: 845-5 Serial No.: 02151271
Date Tested for Accuracy: 1/18/2018
Remarks :test port is leaking
Firm Name : Metro Communication Systems Licensed Tester : Gilbert Morgan
Firm Address : P.O.Box 1267 BPAT License # : BP0015991
Firm Phone No : 972.621.8700 License Expiration Date : 09/30/2020
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.