1301E_BeltLineRd__75019_122904 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-22399
Test Date: 10/16/2020
Result: Passed
Reason for Test: Existing
Account Name : Maple Corner,LLC
Address of Assembly : 1301 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? Domestic
Manufacturer :Febco ByPass : Model No :H60U ByPass : Size :1/2 ByPass : Serial No :H00079 ByPass :
Location At:Back Room
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:10/16/2020
Time:12:00 PM
Held at 8.5 psid
Closed Tight
Leaked
Held at 8.2
psid
Closed Tight
Leaked
Opened at 2.4
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: WILKINS Model: TG5 Serial No.: 06171303
Date Tested for Accuracy: 9/25/2020
Remarks :Device was leaking.Replaced 1st &2nd check.Device passed final test.
Firm Name : A &A Active Backflow Licensed Tester : John Ansley
Firm Address : 1611 N IH 35E BPAT License # : BPAT license
Firm Phone No : (972)242-2229 License Expiration Date : 04/20/2023
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.