1075SBeltline_75019_67384 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-33675
Test Date: 4/3/2019
Result: Passed
Reason for Test: Existing
Account Name : Majestic
Address of Assembly : 1075 S Beltline
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 II Frequency :Annual What does this serve? FireLine
Manufacturer :Febco Model No :805YB Size :1/2 Serial No :06860
Location At:bypass in vault next to 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)?Yes
Reduced Pressure Principle Assembly Pressure Vacuum Breaker
Spilled-Resistant Vacuum BreakerDoubleCheckValveAssembly
1st check 2nd check Relief Valve Air Inlet Check Valve
Initial Test
Date:4/3/2019
Time:9:00 AM
Held at 2.1 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: Non-Potable Make: mid-west Model: 845 Serial No.: 02171596
Date Tested for Accuracy: 3/6/2019
Remarks :
Firm Name : Koetter Fire Protection LLC Licensed Tester : Brett Roppolo
Firm Address : 10351 Olympic Drive BPAT License # : BP0018502
Firm Phone No : (214)358-3593 License Expiration Date : 08/08/2021
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.