NEW_150WStateHwy121_75019_115558 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-87095
Test Date: 8/21/2020
Result: Passed
Reason for Test: New
Account Name : Hat Creek Burger Company
Address of Assembly : 150 W State Hwy 121 : 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? Carbonator
Manufacturer :Watts ByPass : Model No :SS009M3 ByPass : Size :1/2"ByPass : Serial No :26939 ByPass :
Location At:Kitchen
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:8/21/2020
Time:7:25 AM
Held at 9.3 psid
Closed Tight
Leaked
Held at 9.1
psid
Closed Tight
Leaked
Opened at 4.2
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: Mid-West Model: 845-5 Serial No.: 11161416
Date Tested for Accuracy: 2/4/2020
Remarks :
Firm Name : North Texas Backflow Licensed Tester : John Davis
Firm Address : P.O.Box 597 BPAT License # : BP0003132
Firm Phone No : 469-231-6623 License Expiration Date : 06/12/2023
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.