HomeMy WebLinkAboutFire Sprinkler Report - 1/28/11 Form 6
�' Autamatic Sprinkler Systems
Inspection, Testing, and Maintenance
of Wet Pipe Sprinkler Systems
Property Name: Park NiC011et Clinic Inspector: Dan Feiner
Property Address: 16705 Franklin Trail East Prior Lake, MN 55372 Contract No.: 88186
Phone Number: (952) 993-5000 Date: 1/28/2011
This Report Covers: ❑ Monthly ❑ Quarterly ❑ Annual
❑ Three-Year � Five-Year
Inspections
Ma�n'thly
❑ Yes ❑ No � N/A Gauges—normal water pressure maintained
Control Valves
❑ Yes ❑ No � N/A In the correct (open or closed) position
❑ Yes ❑ No � N/A Sealed, locked, or supervised
❑ Yes ❑ No � N/A Accessible
❑ Yes ❑ No � N/A Free from damage or leaks
❑ Yes ❑ No � N/A Proper signage
Alarm Valves
❑ Yes ❑ No � N/A Free of damage
❑ Yes ❑ No � N/A Accessible
❑ Yes ❑ No � N/A Retard chamber/alarm drains not leaking
Quarterly
❑ Yes ❑ No � N/A Alarm devices—free of damage
❑ Yes ❑ No � N/A Hydraulic data nameplat�securely attached to riser/legible
Fire Department Connections
❑ Yes ❑ No � N/A Visible and accessible
❑ Yes ❑ No � N/A Coupling/swivels operate correctly
❑ Yes ❑ No � N/A Plugs/caps aze in place
❑ Yes ❑ No � N/A Gaskets are not damaged
❑ Yes ❑ No � N/A Identification signs are in place
❑ Yes ❑ No � N/A Ball drip valve is functional
Pressure Reducing Valve
❑ Yes ❑ No � N/A In the open position/not lealcing
❑ Yes ❑ No � N/A Maintaining downstream pressure
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Form 6
❑ Yes ❑ No � N/A In good condition
Annual Sprinklers (visible)
❑ Yes ❑ No � N/A No damage or leaks
❑ Yes ❑ No � N/A Free of corrosion, foreign material, or paint
❑ Yes ❑ No � N/A Installed in proper orientation
❑ Yes ❑ No � N/A Fluid in glass bulbs
❑ Yes ❑ No � N/A Spaze sprinklers—proper number and type. Complete witt► wrench?
❑ Yes ❑ No � N/A Hangers and seismic bracing—not damaged or loose
Pipes and Fittings (visible)
❑ Yes ❑ No � N/A In good condition/no external corrosion
❑ Yes ❑ No � N/A No leaks or mechanical damage
❑ Yes ❑ No � N/A Correct alignment no external loads
❑ Yes ❑ No � N/A Hose racks�inspected per NFPA 1962
❑ Yes ❑ No � N/A Building—wet piping not exposed to freezing temperatures
Five-Year
� Yes ❑ No ❑ N/A Alarm valve interior including strainers, filters, and restriction orifice
� Yes ❑ No ❑ N/A Check valve—internal moves freely, in good condition
� Yes ❑ No ❑ N/A Obstruction inspection—no foreign or obstructing material found
Test
Quarterly
❑ Yes ❑ No � N/A Alarm devices—water motor gong
❑ Yes ❑ No � N!A Main drain test if the sole supply is through a backflow preventer
Static psi Residual psi
❑ Yes ❑ No � N/A Do results differ by more than 10% from previous test?
Semi
❑ Yes ❑ No � N/A Supervisory switch functions
❑ Yes ❑ No � N/A Alarm devices—inspectors test or bypass opened/obstructed watertlow
Annual
� Yes [� No � N/A Main drain test Static Residual
❑ Yes ❑ No � N/A Do results differ by more than 10% from previous test?
❑ Yes ❑ No � N/A All control valves operated through full range of motion and returned to normal position.
❑ Yes ❑ No � N/A Specific gravity or anti-freeze system (if present)
❑ Yes ❑ No � N/A Backflow preventer test
❑ Yes ❑ No � N/A Backflow preventer—flow test
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Form 6
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Three-Year
❑ Yes ❑ No � N/A Hose has been tested in accordance with NFPA 1962
Five-Year
� Yes ❑ No ❑ N/A Gauges tested or replaced I
� Yes ❑ No ❑ N/A Pressure reducing valv�flow test and to previous results
Routlne Maintenance I
❑ Yes ❑ No � N/A Sprinklers tested or replaced per appro�riate testing schedule
Comments '
All internal inspection areas look good. There are no obstructiorls.
signature: Dan Feiner Date: 1/28/2011
License/Certification No.: ] 11
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