330SDentonTapRd_75019_70611 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-22224
Test Date: 5/21/2019
Result: Passed
Reason for Test: Existing
Account Name : Legacy ER and Urgent Care
Address of Assembly : 330 S Denton Tap 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 :Wilkins ByPass : Model No :950 ByPass : Size :3/4 ByPass : Serial No :3870699 ByPass :
Location At:in vault @ 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 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:5/21/2019
Time:1:00 PM
Held at 1.6 psid
Closed Tight
Leaked
Held at 2 psid
Closed Tight
Leaked
Opened at 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: Non-Potable Make: Mid-West Instrument Model: 845-5 Test Kit Serial No.: 04180253
Date Tested for Accuracy: 3/25/2019
Remarks :
Firm Name : American Fire Protection Group,Inc Licensed Tester : Darren Levescy
Firm Address : 10575 Vista Park Rd BPAT License # : BP0016252
Firm Phone No : 469-291-8113 License Expiration Date : 12/02/2020
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.