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HomeMy WebLinkAboutWet Pipe Fire Sprinkler System Inspection Report - 8/9/12 . _ , �Z�q73 Form for Inspection, Testing and Maintenance of �n{� QNFSa W et Pipe Fire Sprinkler Systems ` TMPok�u1lM1eFlmBpinMUlndwlry This form covers the minimum requirements of NFPA 25-2008 for wet pipe fue sprinkler systems connected to water supplies without tanks or fire pumps. Separate forms are available for inspection, testing and maintenance of fire pumps, tanks, and other fire protection systems. More frequent inspection, testing and maintenance may be necessary depending on the conditions of the occupancy and the water supply. The work covered on this form is (check one): ❑ Monthly ❑ Quarterly � Annual ❑ Third Year ❑ Fifth Year Owner: Owner's Phone Number: � 2"���` Owner's Address: 2• Property Being Evaluated: �S � � ' Property Address: H � � � Date of Work: �� All responses refer to the current work (inspection,: testing and maintenance) performed on this date. Notes: 1) All questions are to be answered Yes, No, or Not Applicable. All "No" answers are to be explained in Part III of this form. 2) Inspection, Testing and Maintenance are to be performed with water supplies (including fire pumps) in service, unless the impairment procedures of Chapter 15 of NFPA 25 are followed. Part I— Owner's SeCNon 3. Quarterly Inspection Items (continued) c. Pressure reducing valves in open position, not leaking, A.Is the building occupied? 1�] Yes ❑ No � downstream pressure per design criteria, and in good B. Has the occupancy and hazard of contents condition with handwheels not broken? J Yes ❑ No� N/A remained the same since the last inspection? � Yes ❑ No d. Hydraulic nameplate (calculated systems) C. Are all fire protection systems in service? Yes ❑ No securely attached to riser and legible? � Yes ❑ No 0 N/A D.Has the system remained in service without 4. Annual Inspection Items (in addition to above items) modification since the last inspection? �] Yes ❑ No a. Proper number and type of spare sprinklers`?�1 Yes 0 No O N/A E. Was the system free of actuation of devices b. Visible sprinklers: or alarms since the last inspection? J�7 Yes ❑ No 1. Proper position (upright, pendent, sidewall)?�Yes ❑No ❑ N/A F. Name and address of properiy insurance contact: 2. Free of corrosion and physical damage? � Yes 0 No 0 N/A G. Policy number (if known): 3. Proper clearance below sprinklers? ��LI Yes O No O N/A 4. Free of foreign materials including paint. �1 Yes ❑ No ❑ N/A � l �' t,n,�,,, �i 5. Liquid in all glass bulb sprinklers? '� Yes O No ❑ N/A �� � t� U��� 2, i�-t�ti' jv�11 � MZ c. Visible pipe: Owner or Representative (print name) Signatur nd Date 1. In good condition/no external corrosion? `J�1 Yes ❑ No ❑ N/A � Part II - InSpeCto[''S SeCtiOri 2. No mechanical damage or leaks? '1� Yes ❑ No ❑ N/A A. Inspections 3. No externalloads? �1 Yes ❑ No ❑ N(A 1. Daily and Weekly Items d. Visible pipe hangers and seismic braces a. Control valves supervised with seals passed in ection not damaged or loose? � Yes ❑ No 0 N/A in accordance with II.A.2.a below? �Yes ❑ No ❑ N/A e. Hose, hose eouplings and nozzles on sprinkler b. Backflow preventers: system passed inspection per NFPA 1962? ❑ Yes ❑ Nq�l N/A 1. Accessible and isolation valves open? ❑ Yes ❑ No N/A f. Adequate heat in areas with wet piping? � Yes 0 No O N/A 2. Sealed, locked or supervised? ❑ Yes C] No N/A g. Internal inspection of the pipe performed in the 3. Relief port on RPZ not discharging? ❑ Yes ❑ No N/A last 5 years (remove a flushing connection and 2. Monthly Inspection Items (in addition to above items) one sprinkler neaz the end of a branch line)? 0 Yes�No.❑ N/A a. Control valves and valves on backflow (If `7Vo ", conduct internal inspection) preventers with locks or electrical supervision: 5. Fifth Year Inspection Items (in addition to above items) l. In correct (open or closed) position? � Yes 0 No ❑ N/A a. Alarm valves and associated strainers, filters and 2. Lock or supervision in place? �Yes ❑ No ❑ N/A restricted orifices passed internal inspection?❑ Yes 0 No� N/A 3. Accessible and free from external leaks? � Yes 0 No ❑ N/A b. Check valves internally inspected, all parts 4. Provided with appropriate wrenches? 7� Yes 0 No 0 N!A operate properly and are in good condition? ❑ Ye� No 0 N/A 5. Provided with appropriate identification? �] Yes ❑ No ❑ N/A c. Internal pipe inspection performed per 4.g? 0 Yes f�i No ❑ N/A b. Sprinkler wrench with spare sprinklers? � Yes ❑ No a N/A B. Testing c. Gages on system in good condition and Report any failures'on Part III of zhis form. showing normal water supply pressure? `� Yes ❑ No ❑ N/A 1. Quarterly Tests d. Alarm valve free from physical damage, trim a. Mechanical waterflow alarm devices passed in correct (open or closed) position and no tests by opening the inspector's test connection leakage from retarding chamber or drains? ❑ Yes ❑ No� NIA With alarms actuating and flow observed? }� Yes O No 0 N/A 3. Quarterly Inspection Items (in addition to above items) b. Post indicatin g valves o p ened until s prin g or torsion a. Fire department connections visible, accessible, felt in the rod then closed back'/4 turn? ❑ Yes a No� N/A couplings and swivels not damaged, gaskets in c. Main drain test for system downstream of backflow device or place and in good condition, identification sign(s) pressure reducing valve: in place, check valve is not leaking, clapper in place and operating properly and automatic drain v ve in place and operating properly? � Yes �] No ❑ N/A 1. Record static pressure� O psi, residual pressure � psi (Zf plugs or caps are not in place, inspect interior for obstructions) 2• Was flow observed? �j Yes � No ❑ N/A b. Alarm devices free from physical d amage? �1 Yes ❑ No ❑ N/A 3. Are results comparable to previous tests? �I Yes ❑ No O N/A �2009 National Fire Sprinkler Association, 40 Jon Barrett Road, Patterson, NY 12563 (845) 878-4200 Form 25-13W-08 Sheet 1 of 2 :. _,.�.;z:.. � , . , , , . �,- „ , . , _ , . � �. :. ; � _ � t . �. �,����� s�v<c� �'�t�--� � 2 iqy3 + ' � �� 2. Semiannual Tests (in addition to previous items) 8. Abnormally frequent false-tripping of dry-pipe valves a. Valve supervisory switches indicate 9. System is returned to service after an extended period of time movement? � Yes D No O N/A out of service (more ihan one year) b. Electrical watertlow alazm devices passed 10. There is reason to believe the system contains sodium silicate tests by opening inspector's test connection or its derivatives or highly corrosive fliixes in copper pipe with alarms actuating and flow observed? � Yes 0 No O N/A g. If conditions were found that required 3. Annual Tests (in addition to previous items) flushing, was flushing of system conducted? 0 Yes 0 No�N/A a. Main drain test for systems not tested quarterly: h. Was a drain test conducted after opening any r -�� f _ closed valves? ❑ Yes ❑ NoJ� N/A 1. Record Static�.l1_ psi and Residual Pressure �(J � psi i. Adjusted, repaired, reconditioned or replaced components 2. Was flow observed? Yes ❑ No'f:1 NfA had �e associated tests and/or inspections required 3. Are results comparable to previous tests? Yes ❑ No O N/A by Table 5.5.1 of NFPA 25 performed? ❑ Yes ❑ No�l N/A b. Are all sprinklers dated 1920 or later? Yes O No O N/A 2. Annual Maintenance Items (in addition to previous items) c. Sprinklers with fast response elements 20 years a. Operating stem of all OS&Y valves old or more replaced or successfixlly sample lubricated, completely closed, and reopened?�Yes 0 No O N/A tested in Iast 10 years? ❑ Yes a No� N/A b. Sprinklers subject to recall replaced? ❑ Yes ❑ No� N/A d. Standard response sprinklers 50 years old or more replaced or c. Sprinklers and spray nozzles protecting successfully sample tested in last 10 years? ❑ Yes ❑ No� N/A commercial cooking equipment and ventilating e. Standard response sprinklers 75 years old or more replaced or systems replaced except for bulb-type which successfully sample tested in last 5 years? ❑ Yes O No� N/A show no signs of grease build-up? ❑ Yes ❑ No� N/A f. Dry-type sprinkiers replaced or successfutly sample tested in last 10 years? ❑ Yes O Nojl�l N/A PaPt III — CommeIIts (Arry `1Vo " answers, test failures or other g. Antifrceze solution specific gravity: problems found with the sprinkler system must be explained here. 1. Correct at most remote point? ❑ Yes 0 No N/A Also note here cmy products noticed on the system that have been the 2. Correct at interface with wet system? ❑ Yes ❑ No N/A subject of a recall or replacement program.) 3. Correct at other test points (over 150 ga1)? 4'Yes ❑ No N/A l t h. All control valves operated through full range , n �� 'S�C,U �Ck`s 'l"O AC,���I�r�� �t�A�N/��7 and returned to normal posirion? � Yes 0 No a N/A .�� -��,�p t'��Q.S ��,� � a` v e- i. Backflow devices passed backflow test? ❑ Yes ❑ No N/A ��i j. Bacl�low devices passed forward flow test? ❑ Yes 0 No N/A k. Pressure reducing valves passed partial flow? OYes ❑ No N/A � 4. Test for every third year (in addition to previous items) 2 , � t� �� S � ` a 6`'� � Hose more than 5 years old connected to the system � n c��,Q�° � p�J � S��,� �• l��� ` L.� � j�� has been service tested per NFPA 1962. Water discharged and water flow alarms operated? ❑ Yes O Norcl N/A 5. Tests for every fifth year (in additian to appropriate item ) a. Sprinklers above high temperature tested? ❑ Yes a NoJ� /A b. Gages checked by calibrated gage or replaced? OYes ❑No /A c. Pressure reducing valves passed full flow test? ❑Yes ❑No /A C. Maintenance 1. Regular Msintenance Items a. If any sprinkler failed the sampling testing of • Parts II.B3.c, d, e or f of this form, were all sprinklers represented by that sample reptaced? ❑ Yes O No� N/A b. If sprinkler have been replaced, were they proper replacements? ❑ Yes a No�i N/A a Used hose was cleaned, drained and dried before being placed back in service? ❑ Yes ❑ No� N/A d. Hose exposed to hazardous materials was disposed of or decontaminated in an approved manner? ❑Yes ❑No`� N/A e. Systems normally filled with fresh water were drained and refilled twice if raw water got into the system? ❑Yes ❑No `f(�/A Part IV — Inspector's Information f. If any of the following were discovered, was an obstruction investigation conducted? ❑ Yes 0 No� N/A Inspecto r�Q.A�l�n►J IMflt�a0h1 Com �ERAL SPRINKLER CORP. Explain reasons(s) and obstruction investigation findings in Part III �• 1. Defective intake screen on pump supplied from open sources Company Address: �� B�►R LAKE MN 55�1� 2. Obstructive material discharged during flow tests I state that the information on tlus form is correct at the time and 3. Foreign material in dry-pipe valves, check valves or pumps place of my inspection, and that all equipment tested at this time 4. Foreign material in water during drain test or plugging of was left in operating condition upon completion of this inspecrion inspector's test connection except as noted in Part III above. 5. Plugging of pipe or sprinklers found during activation or work p b. Failure to flush yard piping or surrounding mains following Signature of Inspector: ate: i> ' 9'��2- , new installation or repai� 7. R ecor� o f bro m ains in the vi License or Certification Number (if applicable): �7 D�� 02009 National I�ire Sprinkler Association, 40 don Barrett Road, Patterson, NY 12563 (84� 878-4200 Form 25-13W-08 Sheet 2 of 2 � . �. � :� _ ;1 ` ;<';-��a :_�':� ,,. `�F; =�!'£� ".c�v .: ..� :j"' ... . "��; r°x.'.� t.^,.4"