700NDentonTapRd_75019_125748 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-22022
Test Date: 11/10/2020
Result: Passed
Reason for Test: Existing
Account Name : Market Street #564
Address of Assembly : 700 N Denton Tap 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 :009 ByPass : Size :1/2 ByPass : Serial No :A62840 ByPass :
Location At:meat dept under sink
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:11/10/2020
Time:7:00 AM
Held at 5.9 psid
Closed Tight
Leaked
Held at 5.8
psid
Closed Tight
Leaked
Opened at 2.2
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.: 11170008
Date Tested for Accuracy: 12/4/2019
Remarks :This device is listed as a fireline,but it is a domestic line.Please note the location and the area it serves.It has nothing to do
with the fireline.
Firm Name : RES Fire Sprinkler Licensed Tester : Raymond Stephens
Firm Address : P.O Box 185 BPAT License # : BP0018299
Firm Phone No : 972-472-3695 License Expiration Date : 02/26/2021
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.