477W_BethelRoad_75019_125360 BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
Name of PWS:
PWS I.D.:0570040
Address:
,
Phone:
Contact Person:Jerry Davis
Catalog No: TXTCOP-21315
Test Date: 11/4/2020
Result: Passed
Reason for Test: Existing
Account Name : Local Diner (Coppell)
Address of Assembly : 477 W.Bethel Road : 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 :Double Check Valve Frequency :Annual What does this serve? Irrigation
Manufacturer :Watts ByPass : Model No :007M1QT ByPass : Size :1 ByPass : Serial No :450813 ByPass :
Location At:477 W.Bethel Rd.
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:11/4/2020
Time:12:00 PM
Held at 2.2 psid
Closed Tight
Leaked
Held at 2.4
psid
Closed Tight
Leaked
Opened at 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: Longhorn Model: 845-5 Serial No.: 08040583
Date Tested for Accuracy: 9/25/2020
Remarks :
Firm Name : A &A Active Backflow LLC Licensed Tester : Christopher Gafford
Firm Address : 1611 N.IH 35E,Suite 410 BPAT License # : BP0013306
Firm Phone No : 972-242-2229 License Expiration Date : 09/13/2022
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.