HomeMy WebLinkAboutFire Sprinkler Report 11/6/2014 Y
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Work Order:
Form for Inspection, Testing and Maintenance of SUMMIT
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Dry Pipe Fire Sprinkler Systems fire sprinkler systems connected to water supplies without tanks or lire
Thispumps.
form Separate
the minimum requirements inspection,ns ec NFPA ti2 -and for dry pipe p and thefire water supply. The works. covered e frequent this
Se azate forms are available for testing and mon the conditions of the occupancy ks, d other protection systems. More
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inspection,testing and maintenance may be necessary depending
pmgQ Annual ❑Third Year 0 Fifth Year
form is(check one): ❑Weekly ❑Monthly 0 Quarterly Owner's Phone Number: —
Owner:
Owner's Address:
Property Being Evaluated: Bluff hei.hts a i artments erformed on this date.
Property Address: 16638 franklin trail 55372
Date of Work: 11-6-14 All responses refer to the current work(inspection,testing and maintenance)p
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Notes: 1)All questions are to be answered Yes,N ,t be r Not Applicable. All"No"answers are to be explained in Part III of this form.
performed with water supplies(including fire pumps)in service,unless the impairment
2)Inspection,Testing and Maintenance are
procedures of Chapter 15 of NFPA 25 are followed. 3.Quarterly Inspection Items(continued) Yes 0 No 0 N/A
Part I—Owner's Section ®Yes ❑No in place and operating properly?
iti B.Is the building ocy and hazard (If plugs or caps are not in place,inspect interior oorrsob❑st obstructions)
remained
B.Has the occupancy and a the last n pectis
b.Alarm devices free from physical damage.
remained the same since the inspection? ®Yes 0 No c.Pressure reducing valves in open position,not leaking,
DC.Are allh fire sysprottem
systems in service? ®Yes ❑No with downstream pressure per design criteria,and in good
NO N/A
D.Has the aystem remained in service without Yes 0 No condition with handwheels not broken? 0 Yes 0 I!1
modification since the last inspection? ® d.Hydraulic nameplate(calculated systems) No i N/A
E.Was the system freehof actuationnspetiof devices Yes 0 No securely attached to riser and legible? IN Yes 0 or alarms since the last inspection? ®
F.Name and address of property insurance4.Annual Inspection Items(in addition to above items)❑No 0 N/A
contact: a.Proper number and type of spare sprinklers?
b.Visible sprinklers:
1.Proper position(upright,pendent,sidewall)?®Yes 0 No ❑N/A
2.Free of corrosion and physical damage? ®Yes 0 No ❑N/A
G.Policy number(if known): Yes 0 No 0 N/A
*Signature on work order if available. 3.Proper clearance below sprinklers? ®
Owner/Re.resentative Si•nature and Date 4.Free of foreign materials including paint? ®Yes 0 No 0 N/A
0 N/A
Part II-Inspector's Section 5.Liquid in all glass bulb sprinklers? ®Yes 0 No
c.Visible Pipe: Yes 0 No ❑N/A
1. Inspections 1.In good condition/no external corrosion? ®YesNo 0 N/A
1.Daily and Weekly Items 2.No mechanical damage or leaks? ® 0
a. in Control valves supervised with seals passed inspection Yes 0 No 0 N/A 3.No external loads?
®Yes 0 No 0 N/A
Dry pipe accordance with IL enclosures maintailow?ning
® d.Visible pipe hangers and seismic braces ®Yes 0 No 0 N/A
b.of
f4 40°F
valvedgdsingood conditionnns ha minimum not damaged or loose? II Yes 0 No 0 N/A
normal and water and air in rns showing Yes 0 No 0 N/A e.Dry pipe valve passed internal inspection?
normal e and pressure? ® f.Must be done before cold weather: Yes 0 No 0 N/A
c.Backflow preventers: Yes 0 No ®N/A 1.Adequate heat in areas with wet piping? ® N/A
1.Accessibleaoand isolation valves open? 0
2.Sealed,locked or supervised? 0 Yes 0 No ®N/A 2.Low temperature alarms functioning? 0 Yes 0 No
0N/A 3.Interior of pipe that passes through Yes 0 1\o ®N/A
3.Relief port on RPZ not discharging? Yes 0 No ® freezers free of ice blockage? 0
d.For freezer systems,gauge near the compressor reading the
same as the gauge near the dry pipe valve? 0 Yes 0 No NI N/A g.Internal inspection of the pipe performed in the
last 5 years(remove a flushing connection and
2.Monthly Inspectvand Items on addition to above items) one sprinkler near the end of a branch line)? 0
Yes ®No 0 N/A
a.Control valves and valves backflow (If"No"conduct internal inspection)
1.In correctre with(openloor or selectrical) sonervision:
1.In or closed)position? ®Yes 0 No 0 N/A 5.Fifth Year Inspection Items(in addition to above items)
2.Lock orsupervision inplace?
RE Yes 0 No 0 N/A a.Check valves internally inspected,all parts0Yes 0 No IN 3.Accessible and free frommexternal leaks? ®Yes 0 No 0 N/A operate properly and are in good condition.?
Yes 0 No II N/A b.Strainers,filters,restricted orifices and
4.Provided with appropriate wrenches? 0 N/A diaphragm chambers on dry pipe valves and
Yes 0 No ®N/A
5.Provided with te identificaiton? a Yes 0 No 0 N/A trim passed internal inspection? 0 Yes 0 No ®N/A
b.Sprinkler wrench with spare sprinklers?c ®Yes 0 No 0 c.Internal pipe inspection performed per 4.g? 0
c.Dry pipe valve free from physical damage,trim B.Testing
in correct(open or closed)position and no
leakage from intermediate chamber? IM Yes 0 No 0 N/A Report any failures on Part III of this form.
3.Quarterly Inspection Items(in addition to above items) 1. MeQuarterly Tests
al waterflow alarm devices passed
a.Fire department connections visible,accessible, tests by the bypass connection
ouplings and swivels not damaged,gasketsnin
place and in good condition,identification sign(s)
withss alby openingrms the
band flow observed?ec ®Yes 0 No 0 N/A
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in place,check valve is not leaking,clapper in place b.felt in a rtodghen closed b kuvalves opened %altum?ng or tor❑siYes 0 No
Post N/A
and operating properly and automatic drain valve
Summit Fire Protection
575 Minnehaha Avenue West-St.Paul,MN 55103 1 Phone(651)251-1880 1 Page: 1 o
1.Quarterly Tests(continued) 1.Regular Maintenance Items(continued)
c.Priming level correct? 0 Yes 0 No 0 N/A c.Air leaks in dry pipe system resulting in air pressure
d.Low air pressure signal passed test? 0 Yes Cl No 0 N/A loss more than 10 psi/week repaired? 0 Yes ❑No I.N/A
e.Quick opening device passed test? 0 Yes 0 No 0 N/A d.Dry pipe systems kept in dry condition? 0 Yes 0 No L]N/A
f.Main drain test for system downstream of backflow device or e.Have low point drains been emptied? 0 Yes 0 No ❑N/A
pressure reducing valve: If so,how many? 2
1.Record static pressure 70 psi and residual pressure 60 psi f.If any of the following were discovered,was
2.Was flow observed? 0 Yes 0 No 0 N/A an obstruction investigation conducted? 0 Yes 0 No MI N/A
3.Are results comparable to previous tests? 0 Yes ❑No ❑N/A Explain reason(s)and obstruction investigation findings in Part Id
2.Semiannual Tests(in addition to previous items) 1.Defective intake screen on pump supplied from open sources
a.Valve supervisory switches indicate 2.Obstructive material discharged during flow tests
movement? 0 Yes 0 No 0 N/A 3.Foreign material in dry-pipe valves,check valves or pumps
b.Electrical waterflow alarm devices passed 4.Foreign material in water during drain test or plugging of
tests by opening bypass connection inspector's test connection
with alarms actuating and flow observed? 0 Yes 0 No 0 N/A 5.Plugging of pipe or sprinklers found during activation or work
3.Annual Tests(in addition to previous items) 6.Failure to flush yard piping or surrounding mains following
a.Main drain test for systems not tested quarterly: new installation or repairs
1.Record static pressure 70 psi and residual pressure 60 psi 7.Record of broken mains in the vicinity
2.Was flow observed? 0 Yes ❑No ❑N/A 8.Abnormally frequent false-tripping of dry-pipe valves
3.Are results comparable to previous tests? 0 Yes ❑No ❑N/A 9.System is returned to service after an extended period of time
b.Are all sprinklers dated 1920 or later? 0 Yes ❑No ❑N/A out of service(more than one year)
c.Sprinklers with fast response elements 20 years 10.There is reason to believe the system contains sodium silicate
old or more replaced or successfully sample or its derivatives or highly corrosive fluxes in copper pipe
tested in last 10 years? ❑Yes ❑No 0 N/A g.If conditions were found that require
d.Standard response sprinklers 50 years old or more replaced or flushing,was flushing of system conducted? 0 Yes ❑No IO N/A
successfully sample tested in last 10 years? 0 Yes ❑No 0 N/A 2.Annual Maintenance Items(in addition to previous items)
e.Standard response sprinklers 75 years old or more replaced or a.Operating stem of all OS&Y valves
successfully sample tested in last 5 years? ❑Yes ❑No 0 N/A lubricated,completely closed,and reopened? 0 Yes ❑No ❑N/A
f.Dry-type sprinklers replaced or successfully b.Interior of dry pipe valves cleaned? 0 Yes 0 No ❑N/A
sample tested in last 10 years? ❑Yes ❑No 0 N/A c.Low points drained before freezing weather? 0 Yes ❑No ❑N/A
g.All control valves operated through full range d.Sprinklers subject to recall replaced? ❑Yes ❑No O N/A
and returned to normal position? 0 Yes 0 No 0 N/A e.Sprinklers and spray nozzles protecting
h.Low temperature alarms passed test? 0 Yes ❑No 0 N/A commercial cooking equipment and ventilating
i.Dry pipe valve partial flow trip test(unless full trip test done): systems replaced except for bulb-type which
1.Initial air pressure 31 psi and water pressure 70 psi show no signs of grease build-up? ❑Yes ❑No 0 N/A
2.When valve tripped,air pressure 13 psi and time Na sec
3.Are results comparable to previous tests? 0 Yes 0 No 0 N/A Part III—Comments(Any "No"answers,test failures or other
j.Automatic air maintenance devices passed? 0 Yes ❑No ❑N/A problems found with the sprinkler system must be explained here.
k.Backflow devices passed backflow test? ❑Yes 0 No 0 N/A Also note here any products noticed on the system that have been the
1.Backflow devices passed forward flow test? 0 Yes ❑No ❑N/A subject of a recall or replacement program.)
m.Pressure reducing valves passed partial flow?❑Yes ❑No 0 N/A
4.Test for every third year(in addition to previous items) No 5 year internal pipe inspection
Dry pipe full flow trip test: No hydraulic nameplate
a.Initial air pressure psi and water pressure psi Regulator on air maintance device leaks should be replaced
b.When valve tripped,air pressure psi and time sec
c.Water delivery time min sec
Water delivery time not required to be 60 seconds per NFPA 25
d.Are results comparable to previous tests? ❑Yes ❑No 0 N/A
5.Tests for every fifth year(in addition to appropriate items)
a.Sprinklers above high temperature tested? 0 Yes ❑No 0 N/A
b.Gauges checked by calibrated gauge or Part IV—Inspector's Information
replaced? 0 Yes ❑No 0 N/A
c.Pressure reducing valves passed full flow Inspector:Mark himmelspac Company: Summit Fire Protection
test? ❑Yes ❑No 0 N/A
C.Maintenance Company Address: 575 Minnehaha Ave.W.-St.Paul,MN 55103
1.Regular Maintenance Items I state that the information on this form is correct at the time and place
a.If any sprinkler failed the sampling testing of of my inspection,and that all equipment tested at this time was left in
Parts II.B.3.c,d,e or f of this form,were all sprinklers operating condition upon completion of this inspection except as noted
represented by that sample replaced? ❑Yes ❑No 0 N/A in Part III above.
b.If sprinkler have been replaced,were they
proper replacements? ❑Yes ❑No 0 N/A Signature of Inspector: Date: 11-6-14
License or Certification Number(if applicable): J-0278
State License Number - MN:C0075 / IA:FP-036 / WI:656060
Summit Fire Protection 1575 Minnehaha Avenue West-St.Paul,MN 55103 I Phone(651)251-1880 I Page 2 of 2