180SamuelBlvd__75019_121162 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-49101
Test Date: 10/8/2020
Result: Failed
Reason for Test: Existing
Account Name : St.Ann Parish
Address of Assembly : 180 Samuel Blvd. : 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-Detector Assembly Frequency :Annual What does this serve? FireLine
Manufacturer :Ames ByPass : Model No :2000SS ByPass : Size :4 ByPass : Serial No :10319 ByPass :
Location At:Basement Mech 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:10/8/2020
Time:10:25 AM
Held at 0.4 psid
Closed Tight
Leaked
Held at 0 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: WILKINS/ZURN Model: TG5 Serial No.: 03181401
Date Tested for Accuracy: 3/25/2020
Remarks :Both Check valves need to be replaced
Firm Name : RD MOORMAN,INC Licensed Tester : MOSES KEMP
Firm Address : 417 WYNDEMERE BLVD BPAT License # : BP0014971
Firm Phone No : 972-722-2408 License Expiration Date : 11/30/2021
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.