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HomeMy WebLinkAboutWet Pipe Fire Sprinkler System Inspection Report - 8/9/12 �� � � � �� i � � Form for Inspection, Testing and Maintenance of ��{� QNFSA Wet Pipe Fire Sprinkler Systems 15 ��««�Fl���� This form covers the minimum requirements of NFPA 25-2008 for wet pipe fue sprinkler systems connected to water supplies without tanks or fire puxnps. 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 o�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: �K�y vS�r�C"�, Owner's Phone Number: q SZ- ' 2 Z b� b(�1 Owner's Address: �"� � Property Being Evaluated: 'i Property Address: 3 �� � � '" � Date of Work: ��- 2a� 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— OwIIer's SeCtion 3. Quarterly Inspection Items (continued) c. Pressure reducing valves in open position, not leaking, A.Is the building occupied? � Yes ❑ No � downstream pressure per design criteria, and in good B. Has the occupancy and hazazd of contents eondition 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? �Yes ❑ No securely attached to riser and legible? �I Yes O No ❑ N/A D.Has the system remained in serv�xce 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? � Yes ❑ No O 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)? J�Yes ❑No ❑ N/A F. Name and address of property insurance contact: � ; 2. Free of corrosion and physical damage. �J Yes �] No ❑ N/A G. Policy number (if known); 3. Proper clearance below sprinklers? ��Yes O No 0 N/A 4. Free of foreign materials including paint. Yes ❑ No ❑ N/A � g. � 5. Liquid in all glass bulb sprinklers? ❑ Yes � No � N/A �� a Visible pipe: Own or Representative (print name) ignature and Date 1. In good condition/no external corrosion? `§�Yes ❑ No 0 N/A Part II— Inspector's SeCHon 2. No mechanical damage or leaks? � Yes ❑ No ❑ N/A A. InspeCtions 3. No external loads? Yes 0 No ❑ 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 or loose? J� Yes O No ❑ 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 ❑ No�N/A 1. Accessible and isolation valves open? ❑ Yes ❑ No N/A f. Adequate heat in areas with wet piping? � Yes 0 No ❑ N/A 2. Sealed, locked or supervised? ❑ Yes ❑ No N/A g. Internal inspection of the pipe performed in the 3. Relief port on RPZ not discharging? ❑ Yes CI 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 0 N/A 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 ❑ No 0 N/A a. Alarm valves and associated strainers, filters and 2. Lock or supervision in place? `Jd� Yes ❑ No ❑ N/A restricted orifices passed internal inspection?❑ Yes a No � N/A 3. Accessible and free from external leaks? � Yes a No ❑ N/A b. Check valves internally inspected, all parts 4. Provided with appropriate wrenches? � Yes 0 No ❑ N/A operate properly and are in good condition? ❑ Yes�No O N/A 5. Provided with appropriate identification? � Yes ❑ No ❑ N/A a Internal pipe inspection performed per 4.g? ❑ Yes J�1 No 0 N/A b. Sprinkler wrench with spare sprinklers? � Yes ❑ No ❑ 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? �1 Yes ❑ No ❑ N/A 1. Quarterly Tests d. Alarm valve free from physical damage, trim in correct (open or closed) position'and no a. Mechanical waterflow alarm devices passed leakage from retarding chamber or drains? ❑ Yes ❑ No`�N/A tests by opening the inspector's test connection with alanns actuating and flow observed? � Yes ❑ No ❑ N/A 3. Quarteriy Inspection Items (in addition to above items) b. Post indicating valves opened until spring or t sion a F�re department connections visible, accessible, felt in the rod then closed back'/a turn? �Yes 0 No ❑ N/A couphngs and swrveis not damaged, gaskets in c. Main drain test for system downstream of b�ckflow device or place and in good condition, identification sign(s) pressure reducing valve: �}L in place, check valve is not leaking, clapper in piace I' � 2� L,.,���W►5 '� and operating properly and automatic drain valve ` ��� ` 1. Record static pressure � � l psi, residuai pressure� psi : in place and operating properly? 1� Yes ❑ No ❑ N/A 2 Was flow observed? � Yes ❑ No 0 N/A (If plugs or caps are not in place, inspec€ interior for obstructions) 3 Are results comparable fo previous tests? � Yes ❑ No O N/A b: Alarm devices free fromphysical damage? �Yes ❑ No ❑ 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 , � � . � . u.s_'..tF "e.Mrt'nsif �.aa`u�iti�:.... � . `�:� .. . . . . . . .. . � � . . . . . .. . � . h s r`. � ' . . ay . . . � , t .. - . . . . . - . F't . . . . . ... f� . .. � �. � . . . . ' F` . . . , ���.. .�. . : � ,t � _ �: ;4..: ,. '+: . - . . . . . . � ..... '' r, ...,� .. � . 4 � . ... . .. . ' . . r . ._ .. . . . .� . .. � �Je �C-as 1�0/� CI-em���'� � � 191 � _ 2. Semiannual Tests (in addition to previous items) 8. Abnormally frequent false-tripping of dry-pipe valves a. Valv� supervisory switches indicate . 9. System is returned to service after an extended period of #ime 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 silic�te tests by opening inspector's test connecrion or its derivatives or highly conosive flu�ces in copper pipe j with alarms actuating and flow observed? � Yes 0 No 0 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 systems not tested uarte y: h. Was a drain test conducted after opening any , �� 2, - W��{�''S ' p0 closed valves? ❑ Yes O Nd� N/A 1. Record Static \1 psi and Residual Pressure � psi i. Ad justed, re paired, reconditioned or re placed components 2. Was flow observed? Yes O No O N/A had the associated tests and/ar inspections requ�red 3. Are results comparable to previous tests? Yes O No O N/A by Table 5.5.1 of NFPA 25 performed? ❑ Yes ❑ 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) a 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 �] N/A tested in last 10 years? ❑ Yes � 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 yearsT ❑ Yes 0 Na� N/A commercial cooking equipment and ventilating e. Standard response sprinklers 75 yeazs old or more replaced or systems replaced except for bulb-type which successfully sample tested in last 5 years? ❑ Yes a No�l N/A show no signs of grease build-up? � Yes O No ❑ NIA f. Dry-type sprinklers replaced or successfully sample tested in last 10 years? ❑ Yes ❑ No ❑ N/A Part III = Comments (Any ` 1Vo " answers, test failures or other g. Antifreeze solution specific gravity: problems found with the sprinkler system must be explained here. 1_ Correct at most remote point? ❑ Yes ❑ No N/A Also note here any 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 gal)? OYes O No N/A � h. All control valves operated through full range � � ���� � and returned to normal position? � Yes ❑ No O N/A - � . i. Backflow devices passed bacldlow test? ❑ Yes C] No N/A j. Backflow devices passed forward flow test? ❑ 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) n D � Hose more than 5 years old connected to the system � `�� � 5 5 „ has been service tested per NFPA 1962. Water � discharged and water flow alarms operated? ❑ Yes ❑ No�N/A �i� . 5. Tests for every fifth year (in addition to appropriate items) �-7 H �f a. Sprinklers above high temperature tested? ❑ Yes ❑ No�N/A l= ��� C � �J u`�l _ Z� �� �o � b. G ages c hec ke d by ca li bra t e d gag e o r r e p l a c e d? O Ye� No / A '� c. Pressure reducing valves passed full flow test? OYes ❑No� N/A�� `_ / S ) � — �2,�n �`Cvt n Y1C1�} ' h� C. Maintenance ��� � � '� � � � �� u � 1. Regular Maintenance Items a. If any sprinkler failed the sampling testing of p o �• �/ Parts II.B.3.c, d, e or f of this form, were all sprinklers . { C � C � �� represented by that sample replaced? ❑ Yes O No�N/A ' � b. If sprinkler have been replaced, were they _ �,�� „� proper replacements? ❑ Yes O No�l N/A '' w c. Used hose was cleaned, drained and dried ' before being placed back in service? �] Yes O No�] N/A d. Hose exposed to hazardous materials was disposed of or decontaminated in an approyed xnanner? OYes �To� N/A e. Systems normally filled with fresh water were drained and refilled twice if raw water got into the system? ❑Yes ❑No �1v/A Part IV — Inspector's Information f. If any of the following were discovered, was an obstruction invesrigation conducted? ❑ Yes ❑ No� N/A Inspector 1M��► �o���L SPRINKLER CORP. Explain reasons(s) and obstruction investigation,findings in Part III � 1. Defective intake screen on pump supplied from open sources Company Address: WHITE BE�►R LAKE MN • 55110 2. Obstructive material dischazged 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 this time 4. Foreign material in water during drain test or plugging of was left in operating condition upon completion of this inspection inspector's test connecrion except as noted in Part III above. 5. Plugging of pipe or sprinklers found during activation or work 6. Failure to flush yard piping or surrounding mains following Signature of Inspector: �`�`""')ate: - 4'� �Z new installation or repairs 7. Record of broken mains in the vic inity License or Certifica Number (if applicable): �� O3� �2009 National Fire Sprinkler Association, 40 Jon Barrett Road, Patterson, NY 12563 (8457878-4200 Form 25-13W-08 Sheet 2 of 2 �.: ` � _ 4 . � .. -��__„� . � . E . - ,. . ),:.:,�.i' r.. . .��'i���.� . . . . . . e... �. ... _. . �.��.ti ' . . . {�� Tti' Y` {JI i � Y F ..; t .. ...'� - i 1 ��7V . . . . . a �-2��3 _ . ��AI' ,� -�e rS ��� SFRINK�:ER ��t�' S Z- CtJRFC1RATIC►N CONTRACTORS' FOR ALL TYPES OF F/RE SUPPRESS/ON SYSTEMS nnrv uc. # coo2 TRIP TRIP W I Lic. # 222173 I NITIAL POINT TIME ia Lic # FP-046 ZONE # TAMPER ALARM STATIC RESIDUA AIR PSI PSI SEC. REMARKS �� ❑ Main Office: � � � � � � ' � " . � ` 1863 Buerkle Rd. ZONE #1 n White Bear Lake MN55110 + t� �.�` (651) 484-5903 � �(,� ' �/ r,/ �`��� �soo> a�s-s��� ZONE #2 1 i /� �` (651) 484-9514 (� ❑ Wisc. Office: a9a is4�^ Street ZONE #3 Osceola W I 54020 ' (715) 294-4387 (aoo) s�s-s��� ZONE #4 ZONE #5 ZONE #6 ZONE #7 ZONE #8 ZONE #9 ZONE #10 ZONE #11 ZONE #12 - r ZONE #13 � � A '`�'` ` ZONE #14 � ZONE #15 ZONE #16 .._ _ ..ti. -��..�;:s. .