1717E_BeltLineRd__75019_128883 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-22404
Test Date: 12/4/2020
Result: Passed
Reason for Test: Existing
Account Name : St.Marin Apartments
Address of Assembly : 1717 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? FireLine
Manufacturer :Watts ByPass : Model No :009M2 ByPass : Size :2 ByPass : Serial No :120870 ByPass :
Location At:Bldg.13 Fire 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)?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:12/4/2020
Time:10:20 AM
Held at 10.5 psid
Closed Tight
Leaked
Held at 10.5
psid
Closed Tight
Leaked
Opened at 3
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: midwest Model: 845-5 Serial No.: 04142657
Date Tested for Accuracy: 11/3/2020
Remarks :
Firm Name : metro communications Licensed Tester : james harwell
Firm Address : 601 hanover dr #100 BPAT License # : bp0019916
Firm Phone No : (972)621-8700 License Expiration Date : 10/19/2023
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.