HomeMy WebLinkAboutWet Pipe Fire Sprinkler System Inspection Report - 8/9/12 , � s , �2 i�3
` Form for Inspection Testing and Maintenance of ONFSa
Wet Pipe Fire Sprinkler Systems ��� ��a�»Fl�������
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, festing and maintenance of fire pumps, tanks, and other fire protection
systems. More frequent inspection, testing and maintenance may be necessary depending on e 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: S� ���f�_� Owner's Phone Number: Q� ���2�"' ��
Owner's Address: � ��Z 't' M�_ l�I.JC�Z— � N �75 � �
Property Being Evaluated: G
Property Address: 1 �' l' ' ,� �
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 fue pumps) in service, unless the
impairment procedures of Chapter 15 of NFPA 25 are followed.
Part I— Owner's Section 3. Quarterly Inspecfion Items (continued)
A.Is the building occupied? �Yes ❑ No c. Pressure reducing valves in open position, not leaking,
B. Has the occupancy and hazard of contents with downstream pressure per desig� riteria, and in good
remained the same since the last inspection? � Yes ❑ No condition with handwheels not broken. D Yes ❑ No�( N/A
� d. Hydraulic nameplate (calculated systems)
C.Are all fire protection s ystems in service? t� Yes ❑ No securely attached to riser and legible? �Yes 0 No ❑ N/A
AHas the system remained in serv�ce without � 4. A n n u a l In s p ecti on Items (in addition to above items)
modification since the last inspection? � Yes ❑ No a. Proper number and type of spare sprinklers`�Yes ❑ No �] N/A
E. Was the system free of actuation of devices b. Visible sprinklers:
or alarms since the last inspection? �J Yes ❑ No 1. Proper position (upright, pendent, sidewall)? Yes ❑No ❑ N/A
F. Name and address of property insurance contact: 2: Free of corrosion and physical damage? �Yes ❑ No O N/A
G. Policy nu if lrnown): 3. Proper clearance below sprinklers? 7 Yd Yes 0 No O N/A
4. Free of foreign materials including paint. � Yes O No 0 N/A
. g 5. Liquid in all glass bulb sprinklers? � Yes 0 No � N/A
ner or , resentativ rint name e t � c. Visible pipe:
p � 1. In good condition/no external conosion? ,�1 Yes ❑ No ❑ N/A
Part II — InspectoC's SeCtion 2. No mechanical damage or leaks? � Yes ❑ No ❑ N/A
A. Inspection5 3. No external loads? Yes ❑ No ❑ N/A
1. Daily and Weekly Items d. Visible pipe hangers and seismic braces
a. Control valves supervised with seals passed inspection not damaged or loose? �Yes ❑ No ❑ N/A
in accordance with II.A.2.abelow? I�CYes ❑ No ❑ 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? �es ❑ No ❑ N/A
2. Sealed, locked or supervised? ❑ Yes ❑ No N/A g. Internal inspection of the pipe performed in e
3. Relief port on RPZ not discharging? ❑ Yes C] 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)? ❑ �N N/A�j �
a. Control valves and valves on backflow (If No ", conduct internal inspection)
preventers with locks or electrical supervisio • 5. Fifth Year Inspection Items (in addition to above items)
1. In correct (open or slosed) position? Yes �] No O N/A a. Alarm �ialves and associated strainers, filters and
2. Lock or supervision in place? Yes I� No ❑ N/A restricted orifices passed internal inspection?❑ Yes ❑ No�N/A
3. Accessible and free from external leaks? Yes a No O 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� o❑ N/A
5. Provided with appropriate identification? �Yes ❑ No ❑N/A a Internal pipe inspection performed per 4.g? ❑ Yes�No O N/A
b. Sprinkler wrench with spare sprinklers? � Yes O No 0 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 C] No 0 N/A
d. Alarm valve free from physical damage, trim 1. Quarterly Tests
in correct (open or closed) position and no a. Mechanical waterflow alarm de�ices passed
leakage from retarding chamber or drains? ❑ Yes ❑ No� N/A tests by opening the inspector's test conn� ction
3. Quarterly Inspection Items (in addition to above items) with alarms actuating and flow observed. � Yes ❑ No 0 N/A
a. Fire department connections visi b le, accessi b le, 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�N/A .
place and in good condition, identification sign(s) c. Main drain test for system downstream of backflow device ar
in place, check valve is not leaking, clapper in place pressure reducing valve:
and operating properly and automatic drain va ve QQ
in place and operating properly? � Yes C� No ❑ N/A
1. Record staric pressur �� O V psi, residual pressure
(If plugs or caps are not in place, inspect interior or obstructions) 2• Was flow observed? � Yes ❑ No ❑ N/A
b. Alarm devices free from physical damage? �Yes ❑ No [] N/A 3: Are results comparable to previous tests? �i Yes ❑ 1�Io ❑ N/A
�2009 National �ire Sprinkler Association, 40 Jon Barrett Road, Patterson, NY 12563 (845) 878-4200 Form 25-13W-08 Sheetl of 2
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�; •"2; Semiannual Tests (in addition to previous items) � �. Abnormally frequent false-tripping of dry-pipe valves
a. Va1v� supervisory switches indicate 9. System is returned to service after an extended period of time
movement? ` l Yes 0 No 0 N/A out of service (more than one yeaz)
b. Electrical waterflow alarm devices passed 10. There is reason to believe the system cantains sodium silicate
tests by opening inspector's test connection or its derivatives or highly conosive fluxes in copper pipe
with alarms actuating and flow observed? � Yes ❑ 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? O Yes 0 No� N/A
a. Main drain test for stems not tested quarterly: h. Was a drain test conducted after opening any
$� � closed valves? ❑ Yes 0 No�l 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 0 No O N/A by Table 5.5.1 of NFPA 25 performed? ❑ Yes O NoJ� N/A
b. Are all sprinklers dated 1920 or later? Yes 0 No 0 N/A 2. Annual Maintenance Items (in addition to previoas 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 ❑ No a N/A
tested in last 10 years? ❑ Yes O No�N/A b. Sprinklers subject to recall replaced? ❑ Yes ❑ No�1 N/A
d. Standard response sprinklers 50 years old or more replaced or a Sprinklers and spray nozzles protecting
successfully sample tested in last 10 years? ❑ Yes O No,�l N/A commercial cooking equipment and venrilating
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 ❑ No� N/A show no signs of grease build-up? ❑ Yes O No'§� N/A
f. Dry-type sprinklers replaced or successfully
sample tested in last 10 years? ❑ Yes 0 No� N/A PRit III — COmmCIIts (Any `1Vo ° answers, test failures or other
g. Antifreeze solution specific gravity: probdems found with the sprinkler system must be eaplained here.
1. Correct at most remote point? ❑ Yes C7 No N/A Also note here arry 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)? ❑Yes O No N/A � _ y_
h. All control valves operated through full range �� n�
and retumed to normal position? � Yes O No 0 N/A � �� '
i. Backflow devices passed bacl�low test? ❑ Yes 0 No N/A �
j. Backflow devices passed forward flow test? O Yes O No N/A
k Pressure reducing valves passed partial flow7 DYes O No N/A� 1,1 L
4. Test for every third year (in addition to previous items) (�- ,����� b �- -' W�P �L. G�kt�� 4— Z �� �. [�.
Hose more than 5 years old connected to the system
has been service tested per NFPA 1962. Water � * (
discharged and water flow alarms operated? ❑ Yes O No� N/A ��- tJ I�Cl, I'�, L't' C� � t.t/« �: ��Cf¢PS
5. Tests for every 5t�h year (in addition to appropriate items)
a Sprinklers above high temperature tested? ❑ Yes ❑ NoTr� N/A ,
b. Gages checked by calibrated gage or replaced?�Yes �io �i/A � �p�,,�
c. Pressure reducing valves passed full flow test? OYes allo �i/A � r � o � + S � u � f t 4 � P �( , f .
C. Maintenance `-r
1. Regular Maintenance Items
a. If any sprinkler failed the sampling testing of
Parts II.B.3.c, d, e or f of tlris form, were all sprinklers
represented by that sample replaced? ❑ Yes ❑ Nd� N/A
b. ff sprinkler have been replaced, were they
P�P� rePlacements? ❑ Yes 4 No�] N/A
c. Used hose was cleaned, drained and dried .
before being placed back in service? ❑ Yes ❑ N� N/A
d Hose exposed to hazardous materials was disposed
of or decontaminated in an approved manner? aYes allo' 1 N/A
e. Systems normally filled with fresh water were drained and
refilled twice if raw water got into the system? ❑Yes �Io Part IV — Inspector's Informallon
f. If any of We following were discovered, was p ����� �� RP
an obstruction investigation conducted? ❑ Yes a No� N/A Insp�tor:{�A
Explain reasons(s) and obstruction iirvestigation findings in Part III 1$63 BUERKLE RD.
1. Defective intake screen on pump supplied from open sources Company Address: 5110
2. Obstructive material discharged during flow tests I state that the information on this fo s co
3. Foreign material in dry-pipe valves, check valves or pumps place of my inspection, and that all equipment tested at ttus time
4. Foreign material in water during drain test or plugging of was left in operating condition upon mpletion of this inspection
inspector's test connection except as noted in Part III above.
5. Plugging of pipe or sprinklers found�during activation or work Q ���
6. Failure to flush yard piping or surrounc�ing mains following Signature of Inspecto Date: 7 �
new installation ar repairs Q
7. R eco r d of broken ma ins in the vicinity License or Cert ifi c ation Number (if applicable): ���0
�2069 National Fire Sprinkler Association, 40 Jon Barrett Road, Patterson, NY 12563 (84� 87&-42011 Farm 25-13W-08 Sheet 2 of 2
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SPRINKLER
�tJRFt?RATICl11T CONTRACTORS FOR ALL TYPES OF F/RE SUPPRESS/ON SYSTEMS
MN uc. # cooz TRIP TRIP
wi uo. # 222ns INITIAL POINT TIME
ia Lic # FP-046 ZONE # TAMPER ALARM STATIG RESIDUA AIR PSI PSI SEC. REMARKS
❑ Main Office: V ! t _ �/ ��
1863 Buerkle Rd. ZONE #1 �� 1 1�'1 �� 1 �l1 /�
White Bear Lake
MN 55110 � �
(651) 484-5903 � /, („ � Q � � ( „ � �
(aoo� s�s-s��� ZONE #2 Y� � v V!
(651) 484-9514 (�
❑ Wisc. Office:
asa tea�^ Street ZONE #3
Osceola
W I 54020
(715) 294-4387
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ZONE #5
ZONE #6
ZONE #7
ZONE #8
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ZONE #10
ZONE #11
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ZONE #13
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