250WStateHwy121_75019_79360 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-39543
Test Date: 10/7/2019
Result: Passed
Reason for Test: Existing
Account Name : LA Fitness
Address of Assembly : 250 W State Hwy 121
Address Type : Residential
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 :LF909 ByPass : Size :1 1/2 ByPass : Serial No :10642 ByPass :
Location At:Pool Pump Area (pool fill)
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:10/7/2019
Time:1:00 PM
Held at 7 psid
Closed Tight
Leaked
Held at psid
Closed Tight
Leaked
Opened at 2.8
psid
Did not open
Held at psid
Closed Tight
Leaked
Opened at psid
Image: check.gif
Did not
open
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: 845-5-0029 Serial No.: 02152044
Date Tested for Accuracy: 6/29/2019
Remarks :
Firm Name : Backflow Preventer Testing &Repair Service Licensed Tester : Dax Gonzalez
Firm Address : 2616 Handley Dr BPAT License # : BP0015237
Firm Phone No : 817-705-0237 License Expiration Date : 04/30/2022
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.