711Burnet_75019_119753 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-21297
Test Date: 9/24/2020
Result: Passed
Reason for Test: Existing
Account Name : Current water Customer
Address of Assembly : 711 Burnet : 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? Domestic
Manufacturer :Watts ByPass : Model No :LF007M1QT ByPass : Size :1 ByPass : Serial No :021363 ByPass :
Location At:@ meter NW Corner
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:9/24/2020
Time:11:45 AM
Held at 2.4 psid
Closed Tight
Leaked
Held at 2.1
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 Model: TG5 Serial No.: 12142147
Date Tested for Accuracy: 2/7/2020
Remarks :
Firm Name : Approved Backflow Testing Licensed Tester : Douglas Rose
Firm Address : 1303 W Main St BPAT License # : BP0011099
Firm Phone No : 214-477-7002 License Expiration Date : 02/04/2023
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.