1301E_BeltLineRd__75019_81281 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-22399
Test Date: 11/4/2019
Result: Passed
Reason for Test: Existing
Account Name : Maple Corner,LLC
Address of Assembly : 1301 E.Belt Line 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 :Wilkins ByPass : Model No :975XL ByPass : Size :1 ByPass : Serial No :31533553 ByPass :
Location At:in car wash on S.wall
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:11/4/2019
Time:10:00 AM
Held at 7.4 psid
Closed Tight
Leaked
Held at 7.1 psid
Closed Tight
Leaked
Opened at 2.4
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: Potable Make: MacArthur Model: 844-0005 Serial No.: 356763
Date Tested for Accuracy: 11/30/2018
Remarks :
Firm Name : Backflow Testing Licensed Tester : Charles R.Smith
Firm Address : PO Box 825 BPAT License # : BP0012764
Firm Phone No : 940-382-4117 License Expiration Date : 01/20/2022
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.