680NDentonTapRd_75019_73344 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-32765
Test Date: 7/9/2019
Result: Passed
Reason for Test: Existing
Account Name : Current Water customer
Address of Assembly : 680 N 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 :Reduced Pressure Principle Frequency :Annual What does this serve? Domestic
Manufacturer :Watts ByPass : Model No :SS009 ByPass : Size :1/2 ByPass : Serial No :22622 ByPass :
Location At:under CO2 cabinet
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:7/9/2019
Time:1:30 PM
Held at 8.5 psid
Closed Tight
Leaked
Held at 8.3 psid
Closed Tight
Leaked
Opened at 3
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: Wilkins Model: TG-5 Serial No.: 12142147
Date Tested for Accuracy: 2/8/2019
Remarks :
Firm Name : Approved Backflow Testing Licensed Tester : Douglas Rose
Firm Address : 1303 W Main St BPAT License # : BP0011099
Firm Phone No : 214-477-7002 License Expiration Date : 02/04/2020
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.