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HomeMy WebLinkAboutWet Pipe Fire Sprinkler Inspection Report - 8/6/12 _ , t , �Ziq"13 Form for Ins ection Testing and Maintenance of ONFSa Wet Pi e Fire S rinkler S stems ��� ����Fl��aa� P P Y 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 fue 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 Yeaz Owner: Owner's Phone Number: "1�2 �' �� ��• Owner's Address: 2 '1'� � Property Being Evaluated: . � A , � Property Address: � v Date of Work: �- �fl� �LO�ZAII 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 firepumps) in service, unless the impairment procedures of Chapter 15 of NFPA 25 are followed. Part I— Owner's Section 3. Quarterly Inspection Items (continued) : A.Is the building occupied? �1 Yes ❑ No �• Pressure reducing valves in open position, not leaking, B. Has the occupancy and hazard of contents with downstream pressure per design � teria, and in good remained the same since the inspection? � Yes ❑ No condition with handwheels not broken. ❑ Yes ❑ No�NIA C. Are all fire rotection s stems in service? � Yes ❑ No d. Hydraulic nameplate (calculated systems) D.Has the sys em remained in serqxce without securely attached to riser and legible? 'J�Yes � No � N/A modification since the last inspection? � Yes ❑ No 4. Annual Inspection Items (in addition to above items) E. Was the system free of actuation of devices a. Proper number and type of spare sprinklers.J�7 Yes ❑ No 0 N/A b. Visible sprinklers: 1 or alarms since the last inspection? �C] Yes ❑ No 1. Proper position (upright, pendent, sidewall)? �lYes ❑No O N/A F. Name and address of property insurance contact: 2, Free of corrosion and physical damage? �I Yes 0 No 0 N/A G. P' number if 3. Proper clearance below sprinklers? � Yes 0 No O N/A � �' 4. Free of foreign materials including paint? ❑ Yes� No ❑ N/A 5. Liquid in all glass bulb sprinklers? � Yes ❑ No O N/A r or Repre entative ri na e) Signature and Date c. Visible pipe: � 1. In good condition/no extemal corrosion. �Yes ❑ No O N/A Part II — Inspector's Se OII 2. No mechanical damage or leaks? Yes ❑ No ❑ N1A A. Inspections 3. No external loads? �l Yes a No O N/A 1. Daily and Weekly Items d. Visible pipe hangers and seismic braces a. Control valves supervised with seals passed in pection not damaged orloose? � Yes ❑ No 0 N/A in accordance with II.A.2.a below? �Yes ❑ No ❑ N/A e. Hose, hose couplings and nozzles on sprinkler b. Backflow preventers: system passed inspection per NFPA 1962? ❑ Yes U No�l N/A 1. Accessible and isolation valves open? ❑ Yes a No N/A f. Adequate heat in areas with wet piping? �Yes ❑ No ❑ N/A 2. Sealed, locked or supervised? ❑ Yes 0 No N/A g. Internal inspection of the pipe performed in t e 3. Relief port on RPZ not discharging? ❑ Yes 0 No N/A last 5 years (remove a flushing connection and 2. Monthly Inspection Items (in addition to above items) one sprinkler near the end of a branch line)? ❑ Yes� No ❑ NIA a. Control valves 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? � Yes ONo 0 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?❑ Yesi� N N( ��/l 3. Accessible and free from external leaks? Yes C] No ❑ N/A b. Check valves internally inspected, all parts 4. Provided with appropriate wrenches? Yes ❑ No ❑ N/A operate properly and are in good condition? ❑ Yes � No ❑ N/A 5. Provided with appropriate identification? Yes ❑ No � N/A c. Internal pipe inspection performed per 4.g? ❑ Yes �No ❑ N/A b. Sprinkler wrench with spare sprinklers? � Yes O No O N/A B. Testing c. 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. Alarm valve free from physical damage, trim in correct (open ar closed) position and no a: Mechanical waterflow alarm devices passed leakage from retarding chamber or drains? ❑ Yes ❑ No �N1A tests by opening the inspector's test connection 3. Quarterly Inspection Items (in addition to above items) with alarms actuating and flow observed? �d Yes ❑ No ❑ N/A a. Fire department connections visible, accessible, b. Post indicating valves opened until spring or torsion couplings and swivels not damaged, gaskets in felt in the rod then closed back /a turn. ❑ Yes ❑ No�81 N/A place and in good condition, identification sign(s) c. Main drain test for system downstream of bac flow device or in place, check valve is not leaking, clapper in place pressure reducing valve: 2., W� and operating properly and automatic drain valye { mS � U � � 1: Record static pressure psi, residual ressure��psi in place and operating properly. � Yes 0 No O N/A 2 Was flow obseryed? �Yes 0 No 0 N/A (If plugs or caps are not in place, inspect interior for obstructions) b. A larm devices free: from p hysica l d a m a g e? � Y e s ❑ N o ❑ N/ A 3. Are results comparable to previous tests? � Yes 0 No ❑ N1A �2009 National Fire 5prinkler Association, 40 Jon Barrett Road, Patterson, NY 12563 (845) 878-4200 Form 25-13W-08 Sheet 1 of 2 _ _ . . � . - � -- . .. _ . � . .. . , . t- .. . ' � � � � . . �. . . . . , . .. 1 . <. . � / � '• \ ���er���� � Z� `�J3 .� � «� 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 a 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 xest connection or its derivatives or highly conosive fluxes in copper pipe with alarms actuating and flow observed? � Yes O No ❑ N/A g. If conditions were found that required 3. Annual Tests (in addition to previous items) flushing, was flushing of system conducted? ❑ Yes ❑ No� NlA a. Main drain test for s stems not tested quarterly: h. Was a drain test conducted after opening any 8� �� closed valves? ❑ Yes 0 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 ❑ No 0 N/A by Table 5.5.1 of NFPA 25 performed? ❑ Yes ❑ N/A b. Are all sprinklers dated 1920 or later? Yes O No a N/A 2. Annual Maintenance Items (in addition to previous rtems) 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 O No ❑ N/A tested in last 10 years? ❑ Yes O No N/A b. Sprinklers subject to recall replaced? 'L`i Yes ❑ No� N/A d. Standard response sprinklers 50 years old or more replac d 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 O NoJ� N/A f. Dry-type sprinklers replaced or successfully sample tested in last 10 years? ❑ Yes�i No 0 N/A PaTt III —�COmments (Any "No" answers, test failures or other g. Antifreeze solurion 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 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 repl cement program.) 3. Correct at other test points (over 150 gal}? ❑Yes O No N!A , � h. All control valves operated through full range '` and returned to normal position? Yes O No ❑ N/A ' � i. Bacl�low devices passed backflow test? � Yes ❑ No N/A �` � ��� � j. Backflow devices passed forward flow test? O Yes O 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) �� Hose more than 5 years old connected to the system �� r `�,J � �" _�� , has been service tested per NFPA 1962. Water 1 discharged and water flow alarms operated? ❑ Yes ❑ No � N/A c�' �• TJ ��• 5. Tests for every fdth year (in addition to appropriate items) a. Sprinklers above lugh temperature tested? ❑ Yes 0 No N/A b. Gages checked by calibrated gage or replaced? OYes allo /A 3 C A- �, � c. Pressure reducing valves passed full flow test? OYes ❑No /A � � + C. Maintenance ' � �,� 0 1. Regular Maintenance Items � a. If any sprinkler failed the sampling testing of � � �� �'� J � , Parts II.B.3.c, d, e or f of this form, were all sprinkiers �� represented by that sample replaced? ❑ Yes a No�N/A b. If sprinkler have been replaced, were they — `h � R� � proper replacements? ❑ Yes ❑ No�] N/A c. Used hose was cleaned, drained and dried �� ,J �C ln� �� before being placed back in service? ❑ Yes a N� N/A �� � �� f d. Hose exposed to hazardous materials was disposed �P�b �f * �b O(z +fb)!f�"L��� _ of or decontaminated in an approved manner? ❑Yes �io N/A � 1J �D� y , r ?) � e. Systems normally filled with fresh water were drained an� ` � refilled twice if raw water got into the system? OYes �i J�N/A Part IV — Inspector's Informafion f. If any of the following were discovered, was � Q an obstruction investigation conducted? ❑ Yes O Nd`�1 N/A Inspector�P�{tt��t� ��'�1� Company: �, Explain reasons(s) and obstruction investigation findings in Part III * 1. Defective intake screen on pump supplied from open sources Company Address: ��(.�� � Q, �It $i, ,(�� �E �'�� t,�Q ((�� 2. Obstructive material dischazged during flow tests I state that the informarion 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 tlus time 4. Foreign material in water during drain test or plugging of was left in operating condition upon completion of this inspection '�?�� ( p inspector's test connection except as noted in P above. 5. Plugging of pipe or sprinklers found during activation or work �2 �Z 6. Failure to flush yard piping or surrounding mains following Signature of Inspecto • w�ate: � � new installarion oi repairs _ Q 7. R of br in the vi cinity License or Certification Number (if appli able): ���o 02009 National Fire.Spriskl8r Association, 40 don Barrett Road, Patterson, NY 12563 (84� 878-4200 Form 25-�3W-08 Sheet 2 of 2 w- � � :, d _ ,. . E11TE��A►Z. (�. � � E'x`f1P�n � 2�3 �IcUrv�.' SPRINKL�R C+CI�RPtJ!RATIClN CONTRACTORS .FOR ALL TYPES OF F/RE SUPPRESSION SYSTEMS nnrv uc. # cooz TRIP TRIP W I Lic. # 222173 INITIAL POINT TIME ia Lic # FP-046 ZONE # TAMPER ALARM STA7'IC RESIDUA AIR PSI PSI SEC. REMARKS ❑ Main Office: ��� //] f• y �� (� 1863 Buerkle Rd. Z�NE #1 �j , � t� F O /� x ti White Bear Lake MN 55110 y� y �,L� /� � L!, �'� (651) 484-5903 � � � / � � � O h (soo) a�s-s��� ZONE #2 '�� � �-� (651) 484-9514 (f) o wisc. Office: ZONE #3 494 184"� Street Osceola W I 54020 (715) 294-4387 (soo) s�s-s��� ZONE #4 ZONE #5 , � ' ZONE #6 ZONE #7 ZONE #8 ZONE #9 ZONE #10 ZONE #11 ZONE #12 ZONE #13 i „�,,�„ �,.� ZONE #14 �� �� ZONE #15 �� ZONE #16 _ �_::s,���,�::._ .