NEW_180WSandyLakeRd_75019_78994 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 :LF009M3QT ByPass : Size :3/4 ByPass : Serial No :236457 ByPass :
Location At:In kitchen for dishwasher
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:12:21 PM
Held at 6.7 psid
Closed Tight
Leaked
Held at 6.5 psid
Closed Tight
Leaked
Opened at 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.