1717E_BeltLineRd__75019_128924 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 :009M2QT ByPass : Size :2 ByPass : Serial No :119494 ByPass :
Location At:Riser rm.Bldg.#12
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:12:30 PM
Held at 10.9 psid
Closed Tight
Leaked
Held at 10.9
psid
Closed Tight
Leaked
Opened at 3.1
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.