NEW_137TX-121Ste_110_75019_82927 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-69196
Test Date: 11/25/2019
Result: Passed
Reason for Test: New
Account Name : Coppell Pediatric Dentistry
Address of Assembly : 137 TX-121 Ste.110 : 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? Other
Manufacturer :Watts ByPass : Model No :LF009QT ByPass : Size :1/2"ByPass : Serial No :237594 ByPass :
Location At:In utility closet
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)?Yes
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:11/25/2019
Time:8:00 AM
Held at 7.2 psid
Closed Tight
Leaked
Held at 7.4 psid
Closed Tight
Leaked
Opened at 2.9
psid
Did not open
Held at psid
Closed Tight
Leaked
Opened at psid
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: Non-Potable Make: Midwest Model: 845-5 Serial No.: 11130531
Date Tested for Accuracy: 3/11/2019
Remarks :
Firm Name : .01 Accuracy Backflow Licensed Tester : Brian Cox
Firm Address : P.O.Box 6832 BPAT License # : BP0017066
Firm Phone No : 972.699.7156 License Expiration Date : 02/23/2022
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.