NEW_180WSandyLakeRd_75019_78993 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-48195
Test Date: 10/1/2019
Result: Passed
Reason for Test: New
Account Name : Andy's Custard
Address of Assembly : 180 W Sandy Lake 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 :LF009M2QT ByPass : Size :1 1/2 ByPass : Serial No :058587 ByPass :
Location At:North wall next to exit
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:10/1/2019
Time:12:00 PM
Held at 7.8 psid
Closed Tight
Leaked
Held at 7.8 psid
Closed Tight
Leaked
Opened at 3.4
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: Macarthur Model: 844P Serial No.: 03021309
Date Tested for Accuracy: 1/9/2019
Remarks :New device
Firm Name : J.Carroll Plumbing,Inc.Licensed Tester : Jeff Carroll
Firm Address : 8241 Slippery Creek BPAT License # : BP0006553
Firm Phone No : (214)794-5022 License Expiration Date : 04/09/2020
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.