775N_DentonTapSte_110_75019_70129 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-22216
Test Date: 5/8/2019
Result: Passed
Reason for Test: Existing
Account Name : Floyd's 99 Barbershop
Address of Assembly : 775 N.Denton Tap Ste.110
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 :Reduced Pressure Principle Frequency :Annual What does this serve? Domestic
Manufacturer :Watts ByPass : Model No :009M3 ByPass : Size :3/4 ByPass : Serial No :140265 ByPass :
Location At:Mech Room
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 Type II
Assembly
Pressure Vacuum Breaker
Spilled-Resistant Vacuum BreakerDoubleCheckValveAssembly
1st check 2nd check Relief Valve Bypass Check Air Inlet Check Valve
Initial Test
Date:5/8/2019
Time:1:00 PM
Held at 9.2
psid
Closed Tight
Leaked
Held at 8.8 psid
Closed Tight
Leaked
Opened at 2
psid
Did not open
Held at psid
Closed Tight
Leaked
Opened at psid
Did it fully open
Yes No
Held at psid
Leaked
Repairs andMaterialsUsed **
Test After Repair
Date:
Time:
Held at psid
Closed Tight
Leaked
Held at psid
Closed Tight
Leaked
Opened at psid Held at psid
Closed Tight
Leaked
Opened at psid Held at psid
***2nd check:numeric reading required for DCVA only
Test gauge used: Potable Make: MID-WEST Model: 844P Serial No.: 07020975
Date Tested for Accuracy: 12/3/2018
Remarks :
Firm Name : 1-A Fire &Domestic Testing Licensed Tester : Corbin Moyer
Firm Address : PO Box 79548 BPAT License # : BP0015385
Firm Phone No : 817-232-5577 License Expiration Date : 07/12/2019
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.