HomeMy WebLinkAboutFire Sprinkler Report (wet) 11/6/2014w.
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Form for Inspection, Testing and Maintenance of SUMMIT
Wet Pipe Fire Sprinkler Systems
Work Order: 121452 FIRE PROTECTION
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 o:i this
form is(check one): 0 Weekly 0 Monthly 0 Quarterly ■❑Annual 0 Third Year 0 Fifth Year
Owner: Owner's Phone Number:
Owner's Address:
Property Being Evaluated: Bluff heights apartments
Property Address: 16638 franklin trail prior lake mn 55372
Date of Work: 11-6-14 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 impairment
procedures of Chapter 15 of NFPA 25 are followed.
Part I—Owner's Section
3.Quarterly Inspection Items(continued)
c.Pressure reducing valves in open position,not leaking,
B.Has the occupancyyanddupihazard of contents
B.Is the building occupied? Yes 0 No with downstream pressure per design criteria,and in good
d?
remained the same since the last inspection? ji Yes 0 No condition with handwheels not broken? 0 Yes 0 No 6!N/A
C.Are all fire protection systems in service? 1.1 Yes ❑No d.Hydraulic nameplate(calculated systems)
D.Has the system remained in service without securely attached to riser and legible? 0 Yes ®No []N/A
modification since the last inspection? ®Yes 0 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? ®Yes 0 No ❑N/A
or alarms since the last inspection? ❑■ Yes 0 No b.Visible sprinklers:
F.Name and address of property insurance contact: 1.Proper position(upright,pendent,sidewall)?®Yes 0 No I]N/A
2.Free of corrosion and physical damage? ®Yes 0 No I]N/A
3.Proper clearance below sprinklers? ®Yes 0 No 0 N/A
G.Policy number(if known): 4.Free of foreign materials including paint? 0 Yes ®No 0 N/A
5.Liquid in all glass bulb sprinklers? ®Yes 0 No 0 N/A
*Signature on work order if available. c.Visible Pipe:
Owner/Representative Signature and Date 1.In good condition/no external corrosion? ®Yes 0 No ❑N/A
Part II—Inspector's Section 2.No mechanical damage or leaks? ®Yes 0 No ❑N/A
A.Inspections 3.No external loads? ®Yes 0 No 0 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 0 No 0 N/A
in accordance with II.A.2.a below? II Yes 0 No 0 N/A e.Hose,hose couplings and nozzles on sprinkler
b.Backflow preventers: system passed inspection per NFPA 1962? 0 Yes 0 No II N/A
1.Accessible and isolation valves open? 0 Yes 0 No IN N/A f.Adequate heat in areas with wet piping? 1 Yes 0 No 0 N/A
2.Sealed,locked or supervised? 0 Yes 0 No ®N/A g.Internal inspection of the pipe performed in the
3.Relief port on RPZ not discharging? 0 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)? 0 Yes ®No 0 N/A
a.Control valves and valves on backflow (If"No"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 0 No ❑N/A a.Alarm valves and associated strainers,filters and
2.Lock or supervision in place? ®Yes 0 No 0 N/A restricted orifices passed internal inspection? 0 Yes 0 No ®N/A
3.Accessible and free from external leaks? In Yes 0 No 0 N/A b.Check valves internally inspected,all parts
4.Provided with appropriate wrenches? 0 Yes 0 No ®N/A operate properly and are in good condition? 0 Yes 0 No II N/A
5.Provided with appropriate identificaiton? ®Yes 0 No 0 N/A c.Internal pipe inspection performed per 4.g? 0 Yes 0 No It N/A
b.Sprinkler wrench with spare sprinklers? ®Yes 0 No 0 N/A B.Testing
c.Gauges on system in good condition and Report any failures on Part III of this form.
showing normal water supply pressure? ®Yes 0 No 0 N/A 1.Quarterly Tests
d.Alarm 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? 0 Yes 0 No ®N/A with alarms actuating and flow observed? IN Yes 0 No 0 N/A
3.Quarterly Inspection Items(in addition to above items) b.Post indicating valves opened until spring or torsion
a.Fire department connections visible,accessible, felt in the rod then closed back V4 turn? 0 Yes 0 No ®N/A
couplings and swivels not damaged,gaskets in c.Main drain test for system downstream of backflow device or
place and in good condition,identification sign(s) pressure reducing valve:
in place,check valve is not leaking,clapper in place 1.Record static pressure 70 psi and residual pressure 60 psi
and operating properly and automatic drain valve 2.Was flow observed? ®Yes 0 No 0 N/A
in place and operating properly? III Yes 0 No 0 N/A 3.Are results comparable to previous tests? NO Yes 0 No 0 N/A
(If plugs or caps are not in place,inspect interior for obstructions)
b.Alarm devices free from physical damage? 1.1 Yes 0 No 0 N/A
Summit Fire Protection 1575 Minnehaha Avenue West-St.Paul,MN 55103 I Phone(651)251-1880 I Page 1 of 2
2.Semiannual Tests(in addition to previous items) 1.Regular Maintenance Items(continued)
a.Valve supervisory switches indicate 6.Failure to flush yard piping or surrounding mains following
movement? It Yes 0 No ❑N/A new installation or repairs
b.Electrical waterflow alarm devices passed 7.Record of broken mains in the vicinity
tests by opening inspector's test connection 8.Abnormally frequent false-tripping of dry-pipe valves
with alarms actuating and flow observed? It Yes ❑No ❑N/A 9.System is returned to service after an extended period of time
3.Annual Tests(in addition to previous items) out of service(more than one year)
a.Main drain test for systems not tested quarterly: 10.There is reason to believe the system contains sodium silicate
1.Record static pressure 70 psi and residual pressure 60 psi or its derivatives or highly corrosive fluxes in copper pipe
2.Was flow observed? ®Yes 0 No ❑N/A g.If conditions were found that require
3.Are results comparable to previous tests? ®Yes 0 No ❑N/A flushing,was flushing of system conducted? 0 Yes 0 No It N/A
b.Are all sprinklers dated 1920 or later? IM Yes 0 No ❑N/A h.Was a drain test conducted after opening any
c.Sprinklers with fast response elements 20 years closed valves? ®Yes 0 No 0 N/A
old or more replaced or successfully sample i.Adjusted,repaired,reconditioned or replaced components
tested in last 10 years? 0 Yes 0 No ®N/A had the associated tests and/or inspections required
d.Standard response sprinklers 50 years old or more replaced or by Table 5.5.1 of NFPA 25 performed? 0 Yes 0 No It N/A
successfully sample tested in last 10 years? ❑Yes 0 No ®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? 0 Yes 0 No ®N/A lubricated,completely closed,and reopened? ®Yes 0 No N/A
f.Dry-type sprinklers replaced or successfully b.Sprinklers subject to recall replaced? 0 Yes 0 No a N/A
sample tested in last 10 years? 0 Yes 0 No ®N/A c.Sprinklers and spray nozzles protecting
g.Antifreeze solution specific gravity: commercial cooking equipment and ventilating
1.Correct at most remote point? ❑Yes ❑No ®N/A systems replaced except for bulb-type which
2.Correct at interface with wet system? 0 Yes 0 No ®N/A show no signs of grease build-up? ❑Yes 0 No IM N/A
3.Correct at other test points(over 150 gal)? 0 Yes 0 No ®N/A
h.All control valves operated through full range Part III—Comments(Any "No"answers,test failures or other
and returned to normal position? ®Yes ❑No ❑N/A problems found with the sprinkler system must be explained here.
i.Backflow devices passed backflow test? 0 Yes 0 No ®N/A Also note here any products noticed on the system that have been the
j.Backflow devices passed forward flow test? ®Yes 0 No ❑N/A subject of a recall or replacement program.)
k.Pressure reducing valves passed partial flow?®Yes 0 No ❑N/A
4.Test for every third year(in addition to previous items) No 5 year internal pipe inspection
Hose more than 5 years old connected to the system No hydraulic nameplate
has been service tested per NFPA 1962. Water Garage 26 1 painted dry horizontal sidewall head
discharged and water flow alarms operated? 0 Yes 0 No ®N/A
5.Tests for every fifth year(in addition to appropriate items)
a.Sprinklers above high temperature tested? 0 Yes ❑No Ft N/A
b.Gauges checked by calibrated gauge or
replaced? 0 Yes ❑No ®N/A
c.Pressure reducing valves passed full flow
test? ❑Yes ❑No ❑■ N/A
C.Maintenance
1.Regular Maintenance Items
a.If any sprinkler failed the sampling testing of
Parts II.B.3.c,d,e or f of this form,were all sprinklers
represented by that sample replaced? 0 Yes ❑No ®N/A
b.If sprinkler have been replaced,were they
proper replacements? 0 Yes 0 No ❑■ N/A
c.Used hose was cleaned,drained and dried
before being placed back in service? 0 Yes 0 No ®N/A
d.Hose exposed to hazardous materials was disposed of
or decontaminated in an approved manner? ❑Yes ❑No ®N/A Part IV—Inspector's Information
e.Systems normally filled with fresh water were drained and refilled
twice if raw water got into the system? ❑Yes ❑No ®N/A Inspector:Mark himmelspac Company: Summit Fire Protection
f.If any of the following were discovered,was
an obstruction investigation conducted? 0 Yes 0 No ®N/A Company Address: 575 Minnehaha Ave.W.-St.Paul,MN 55103
Explain reason(s)and obstruction investigation findings in Part III I state that the information on this form is correct at the time and place
1.Defective intake screen on pump supplied from open sources of my inspection,and that all equipment tested at this time was le13 in
2.Obstructive material discharged during flow tests operating condition upon completion of this inspection except as noted
3.Foreign material in dry-pipe valves,check valves or pumps in Part III above.
4.Foreign material in water during drain test or plugging of Signature of Inspector: Date: 11-6-14
inspector's test connection License or Certification Number(if applicable): J-0278
5.Plugging of pipe or sprinklers found during activation or work 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