HomeMy WebLinkAboutWet Pipe Fire Sprinkler Inspection Report - 8/6/12 ,
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Form for I�spection, Testing and Maintenance of 1VU]�{� QNFS'a
Wet Pipe Fire Sprinkler Systems L�`� 15 ��««��Fl��^�a�^��
This form covers the minimum requirements of NFPA 25-2008 for wet pipe fire 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: ���i�"� Sys'[�.S � l� �,� Owner's Phone Number: q 52 "' ��D"� d��
Owner's Address: 2 `� �'t'� � �� �-- �L\ `� � � � �'
Properiy Being Evaluated:
Property Address: � ' ��
Date of Work: !J'�'G���Z 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
impairrnent procedures of Chapter 15 of NFPA 25 are followed.
Part I— Owner's Section 3. Quarterty Inspection Items (continued)
c. Pressure reducing valves in opemposition, not leaking,
A.Is the building occupied? �Yes ❑ No � downstream pr�ssure per design criteria, and in good
B. Has the occupancy and hazard of contents condition with handwheels not broken? � 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? R'Yes ❑ No securely attached to riser and legible? ,� Yes f] No � N/A
AHas the system remained in serv without 4. Annual Inspectionitems (in addition to abov items)
modification since the last inspection? ❑ Yes R'No a. Proper number and type of spare sprinklers?�Yes ❑ No 0 N/A
E. Was the system free of actuation of devices b. Visible sprinklers:
or alarms since the last inspection? `` ❑ Yes �'No 1. Proper position (upright, pendent, sidewall)`?�Yes �To I� N!A
F. Name and address of property insurance contact: 2. Free of corrosian and physical damage? 1�i Yes ❑ No ❑ N/A
, G. Policy number (if known): 3. Proper ciearance below sprinklers? ��I Yes a No 0 N/A -
4. Free of foreign materials including paint. :�1 Yes a No ❑ N/A
___����,V�--�""'� /f4f��C 0�6�� �'" 5. Liquid in all glass bulb sprinklers? � Yes O No a N/A
Owner or Re resentative nnt name Si ature and Date c. Visible pipe:
p � � � 1. In good condition/no external corrosion? Yes O No ❑ N/A
Part II — Inspector's Section 2. No mechanical damage or leaks? � Yes ❑ No 0 N/A
A. Inspections 3. No external loads? '�Q Yes ❑ No ❑ N/A
1. Daily aud Weekly Items d. Visible pipe hangers and seismic braces
a. Control valves supervised with seals passed in ection not damaged or loose? � Yes 0 No ❑ N/A
in accordance with II.A.2.a below? �Yes 0 No O N/A e. Hose, hose couplings and nozzles on sprinkler
b. Backflow preventers: system passed inspection per NFPA 1962? ❑ Yes ❑ No�N/A
1. Accessible and isolation valves open? ❑ Yes ❑ No N/A f. Adequate heat in areas with wet piping? � Yes O 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 sprinklernear the end of abranch line)? a Yes�No C] N/A
a. Control vaives and valves on backflow (If `1Vo ", conduct internal inspection)
preventers with locks or electrical supervision: 5. Fifth Year Inspection Items (in addition to above items)
1. In correct (open or closed) position? y� Yes I� No 0 N!A a. Alarm valves and associated strainers, filters and
2. Lock or supervision in place? J� Yes 0 No ❑ N/A restricted orifices passed internal inspection?O Yes ❑ No� N/A
3. Accessible and free from external leaks? �i Yes 0 No ❑ N/A b. Check valves internally inspected, all parts
4. Provided with appropriate wrenches? � Yes a No ❑ N/A operate properly and aze in good condition? C] Yes� No ❑ N/A
5. Provided with appropriate identification? �l Yes� No ❑ N/A c. Internal pipe inspection performed per 4.g? ❑ Yes�l No a N/A
b. Sprinkler wrench with spare sprinklers? � Yes � No ❑ N/A B. Testiug
a Gages on system in good condition and Report any failures on Part III of this form.
showing normal water supply pressure? � Yes ❑ No ❑ N/A 1. Quarterly Tests
d. Alann 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�l N/A � alarms actuating and flow observed? �Yes ❑ No ❑ N/A
3. Quarterly Inspection Items (in addition to above items) b. Post indicating valves opened until spring or torsion
a. Fire deparhnent connections visible, accessible, felt in the rod then closed back'/4 turn? ❑ Yes'�No a N/A
couplings and swivels not damaged, gaskets in c. Main drain test for system downstream of �ckflow device or
place and in good condition, identification sign(s) pressure reducing valve:
in place, check valve is not leaking, clapper in place Qt'� � � S}�',�wS �
and operating properly and automatic drain valve �� � �
i n p l a c e a n d o p e r a t i n g p r o p e r l y? '� Y e s ❑ N o O N/ A
L R e c o r d s t a t i c p r e s s u r e� p s i, r e s i d u a l pr e ssure� psi
(If plugs or caps are not in place, inspect interior or obstructions) 2• Was flow observed? � Yes ❑ No C] N/A
b. Alarm devices free from physical damag �Yes ❑ No ❑ N 3. Are results comparable to previous tests? �{I Yes O No ❑ N/A
�2009 National Fire Sprinkler Associatiou, 40 Jon Barrett Road, Patterson, NY 12563 (845) 878-420Q Form 25-13W-08 Sheet 1 of 2
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2. Semiannual Tests (in additioa 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 0 No ❑ N/A out of service (more than one year)
b. Electrical waterflow alarm 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 alanns actuating and flow observed? � Yes ❑ No ❑ 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�/A
a. Main drain test for s stems not tested quarterly: h. Was a drain test conducted after opening any
g� � closed valves? ❑ Yes a No,,$'� N/A
1. Record Static psi and Residual Pressure �psi i. Adjusted, repaired, reconditioned or replaced components
2. Was flow observed? Yes ❑ No ❑ N/A had the associated tests and/or inspections required
3. Are results comparable to previous tests? Yes a No O N/A by Table 5.5.1 of NFPA 25 performed? ❑ Yes a No� N/A
b. Are all sprinklers dated 1920 or later? Yes O No ❑ 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 successfully sample lubricated, completely closed, and reopened?/�Yes O No O N!A
tested in last 10 years? O Yes 0 No^�N/A b. Sprinklers subject to recall replaced? ❑ Yes ❑ No}�N/A
d. Standard response sprinklers 50 years old or more replaced or a Sprinklers and spray nozzles protecting
successfully sampie tested in last 10 years? ❑ Yes O No� N/A commercial cooking equipment and venrilating
e. Standard response sprinklers 75 years old or more replaced or systems replaced except for bulb-type wluch
successfully sample tested in last 5 years? ❑ Yes 0 No� N/A show no signs of grease build-up? ❑ Yes ❑ Nq.� N/A
f. Dry-type sprinklers replaced or successfully
sample tested in last 10 years? ❑ Yes 0 No�l N/A Psrt III — COmments (Any ``No" answers, test failures or other
g. Antifreeze solution specific gravity: problems found with the sprinkler system must be eaplained here.
1. Correct at most remote point? ❑ Yes O No N/A Also note here any products noticed on the system that have been the
2. Correct at interface with wet system? ❑ Yes O No N/A subject of a recall or replacement program.)
3. Correct at other test points (over 150 gal)? C]Yes ❑ No N/A
h. All control valves operated through fuil range � ��� B D�
and returned to normal position? �'Yes ❑ No ❑ N/A '�� �� �� �
i. Bacl�low devices passed backflow test? ❑ Yes a No N/A
j. Backflow devices passed forward flow test? O Yes ❑ No N/A
k. Pressure reducing valves passed partial flow? OYes O No N/A ' �
4. Test for every third year{in addition to previous items) � C �� � `
Hose more than 5 years old connected to the system �ht� .�� � � � t� �� W� f'�
has been service tested per NFPA 1962. Water
dischazged and water flow alarms operated? ❑ Yes O No'� N/A n� 2 LtJ liz I S �
5. Tests for every fifth year (in addition to appropriate items) L� ,(�
a. Sprinklers above lugh temperature tested? ❑ Yes f� NoJl�N/A '" ' `� e � •
b. Gages checked by calibrated gage or replaced? OYes�io aN/A
c. Pressure reducing valves passed full flow test7 OYes ❑No �N/A
C. Maintenance Dr� !
1. RegularMaintenance Items ^ ,
�
a. If any sprinkler failed the sampling testing of / �- i i.J � �/Y! �,r S� C
- Parts II.B.3.c, d, e or f of this form, were all sprinklers
represented by that sample replaced? ❑ Yes ❑ No�ON/A w` �Q � �� d
b. If sprinkler have been replaced, were they
proper replacements? ❑ Yes O No.$►N/A
c. Used hose was cleaned, drained and dried
before being placed back in service? ❑ Yes O No� N/A 2 D � �/ v
d. Hose exposed to hazardous materials was disposed —�—
of or decontaminated in an approved manner? ❑Yes ONoJ�i N/A ��/ b�
e. Systems normally filled with fresh water were drained and '�' p
refilled twice if raw water got into the system? OYes allo Part IV — Inspector's Informallon
f. If any of the following were discovered, was � P �j, ���� ������
an obstruction investi afion conducted? ❑ Yes ❑ N N/A Ins ector: D � �Nid.ER COF�P
Explain reasons(s) and obstruction irrvestigation findings in Part Ill �� BVERb.E RD.
1. Defective intake screen on pump supplied from open sources Company Address: ..,, „r� cxGAR LAKE MN 55110
2. Obstructive material discharged during flow tests I state that the information on this 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 tivs time
4. Foreign material in water during drain test or plugging of was left in operating condition upon compl 'on of tlus inspection
inspector's test connection except as noted in P above.
5. Plugging of pipe or sprinklers found during activarion or work p '� f/Z
6. Failure to flush yard piping or surrounding mains following Signahue of Insp Date: d Gv
. new installation or repairs ,� �
7. Recor� of broken mains in the vicinity License or Certification Number (if applicable):
�2009 National Fire Sprinkler Association, 40 don Barrett Road, Patterson, NY 12563 (84� 878-4200 Form 25-�3W-08 Sheet 2 of 2
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SPI�INI�L�R � � (9 �I Z
Ct3RFt?RATI+LIN CONTRACTORS FOR ALL TYPES OF F/RE SUPPRE�ON SYS EMS
nnrv ��c. # coo2 TRIP TRIP
W I Lic. # 222173 I NITIAL POINT TIME
ia Lic # FP-046 20NE # TAMPER ALARM STATIC RESIDUA AIR PSI PSI SEC. REMARKS
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❑ Main Office: y( � ��
1863 Buerkle Rd. ZONE #1 V X QC. ��} S
White Bear Lake
MN 55110 ��
(651) 484-5903 � � A � Q
(eoo) s�e-s��� ZON E #2 ��� ��� v � t � �lvt
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{651) 484-9514 (f)
❑ Wisc. Office:
494 184'h Street ZONE #3
Osceola
W I 54020
(715) 294-4387
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