106NDentonTapRd_75019_79117 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-22024
Test Date: 10/4/2019
Result: Passed
Reason for Test: Existing
Account Name : Tom Thumb
Address of Assembly : 106 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 :Double Check Valve Frequency :Annual What does this serve? FireLine
Manufacturer :Hersey ByPass : Model No :DC ByPass : Size :3/4 ByPass : Serial No :182385 ByPass :
Location At:vault on SE corner
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:9:15 AM
Held at 2.2 psid
Closed Tight
Leaked
Held at 2.2 psid
Closed Tight
Leaked
Opened at 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: Midwest Model: 845-5 Serial No.: 07191075
Date Tested for Accuracy: 7/16/2019
Remarks :
Firm Name : !!!Next Day Backflow Testing Licensed Tester : Eric Croson
Firm Address : 1417 Abilene ct BPAT License # : BP0018898
Firm Phone No : 214-218-6415 License Expiration Date : 01/10/2022
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.