230NDentonTapRd#115_75019_79260 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-22023
Test Date: 10/4/2019
Result: Passed
Reason for Test: Existing
Account Name : Coppell Modern Dentistry
Address of Assembly : 230 N Denton Tap Rd #115
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 :009 ByPass : Size :1/2 ByPass : Serial No :357226 ByPass :
Location At:equipment 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:10/4/2019
Time:11:53 AM
Held at 7.9 psid
Closed Tight
Leaked
Held at 8.3 psid
Closed Tight
Leaked
Opened at 4
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 Serial No.: 08160372
Date Tested for Accuracy: 8/13/2019
Remarks :Complete rubber kit was used to repair device
Firm Name : A.C.E.Companies Licensed Tester : Marcus Ruiz
Firm Address : 150 East Highway 67 Ste 210 BPAT License # : BP0016108
Firm Phone No : 469-899-6050 License Expiration Date : 10/23/2020
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.