940W_BethelRd__75019_51288 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-28056
Test Date: 9/26/2018
Result: Failed
Reason for Test: Existing
Account Name : Amazon,LLC
Address of Assembly : 940 W.Bethel 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 Assembly Frequency :Annual What does this serve? FireLine
Manufacturer :Watts Model No :774 Size :12" Serial No :100297
Location At:In Vault North of Building
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:9/26/2018
Time:1:05 PM
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 **
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 G Model: 845-5-0006 Serial No.: 03050223
Date Tested for Accuracy: 10/11/2017
Remarks :#1 SHUT OFF VALVE WOULD NOT SHUT
Firm Name : Fire &Life Safety America Licensed Tester : Jeremy Daugherty
Firm Address : 2821 W Euless Blvd BPAT License # : BP0017079
Firm Phone No : 972-224-9380 License Expiration Date : 09/30/2019
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.