HomeMy WebLinkAboutSentry Fire Protection Inc. S E N T RT FIRE PROTECTION INC.
4439 Hwy.-12 SW, P.O. Box 69 Waverly,Minnesota 55390 612-658-4483 Fax#:612-658-4921
Form for Inspection, lbsting and Maintenance of Fire Sprinkler Systems sheet 1 ore
Information on this form covers the minimum requirements of NFPA 25-1992 for fire sprinkler systems connected to distribution systems
without supplemental tanks or fire pumps. Separate forms are available to inspect,test and maintain fire pumps and water tanks. Additional
forms are also available for standpipe and hose systems,private fire service mains,water spray fixed systems and foam-water sprinkler systems.
More frequen tion,testing end maintenance may be n es ary dypending on the conditions of the occupancy and the water supply.
Owner:�N 0 /I'1 anlle55o if I SPC n o o L
Owner's Address:
Property Being Inspected: SG11010L.
Property Address: 3FOO 2$ u T400G, 447�"f_ �
Date of Inspection: "U All responses refer to the current inspection performed on this date.
This inspection is (check one): 0 Daily 0 Weekly 0 Monthly O Quarterly 0 Semiannual X Annual ❑ Third Year ❑ Fifth Year
Note: All questions are to be answered Yes.No,or Not Applicable. All"No"answers are to be explained in the comments portion of this form.
Part I QWfiler'S Section 4.Monthly Inspection Items(Continued)
A.Is the buildmg occupied?; Yes O No O N/A F.Sprinkler Pressure Regulating Control Valves:
B. Hasthe classification and hazar of tents remained 1.In open position? O Yes O NodN/A
the same since the last inspection? Yes O:Nn O N/A
C. Are all'ftre protection systems in service?` rs O No;O N/A 2.Not leaking. O Yes ❑No,�N/A
D. Has the;system remained m-service without modifieatton since the 3.Maintaining downstream pressure per design criteria.
last inspection? es O No O N/A O Yes 0 No QN/A
E. 4.In good condition with handwheels not broken?❑Yes ONoI/A
Was the system free o ' [mations devices arms since the
r#st inspection? Yes O No 0 N/A G.Fire Department Connections:
1.Visible and accessible? Wfes 0 No O N/A
at2.Couplings and swivels not damaged and rotate smoothly??Owner or Representative Tint name Signature and DeYes o No
O N/A II• Inspectors Section
f
A.Inspections 3.Plugs or caps in place and undamaged? Yes 0 No ❑N/A
1.Daily,or weekly it low temperature alarms are installed 4.Gaskets in place and in good condition? Q'Ifes 0 No ❑N/A
Enclosures around dry-pipe,preaction or deluge valves maintaining 5.Identification sign(s)in place? Ad*fes 0 No 0 N/A
a minimum of 40°F? ❑Yes O No X N/A 6.Check valve is not leaking? gYes 0 No ❑N/A
2.Weekly Inspection Items 7.Automatic drain valve in place and operating properly?
A.Pmaction and Deluge Valves: Uttes 0 No 0 N/A
1.Free from physical damage? 0 Yes 0 No qxN/A (Note: If plugs or caps are not in place,inspect the interior for
2.Trim valves in appropriate(open orclosed)position and no obstructions and verify that the valve clapper is operational over its
leakage frgm valve seat? O Yes 0 No WN/A full range.)
3.Electrics components in service? 0 Yes 0 No Rf N/A S.Quarterly Inspection Item
B.Dry-Pipe Valves: Hydraulic nameplate,if provided,securely attached to riser and
1.Free from physical damage? ❑Yes ONO id N/A legible? Yes 0 No 0 N/A
2.Trim valves in appropriate(open or closed)position? 6.Annual Inspection Items
O Yes 0 No 0 N/A A.Visible sprinklers:
3.No leakage from intermediate chamber? 0 Yes O No RrN/A 1.Free of corrosion? JOYes O No 0 N/A
C.Relief port on reduced pressure backflow prevention assemblies 2.Free of obstructions to spray patterns? James ❑No O N/A
free of continuous dischare? O Yes O No 0 N/A 3.Free of foreign materials including paint? O'Yes ❑No 0 N/A
3.Weekly inspection items which can be performed monthly if the 4.Free of physical damage? eYes 0 No 0 N/A
Items are electrically supervised or secured with locks B.Visible pipe:
A.Gauges on dry,preaction and deluge systems in good condition and 1.In good condition? WYes O No O N/A
showing normal air and water pressure? O Yes O No)dN/A 2.Free of mechanical damage and not leaking?;'Yes O No 0 N/A
B.Control valves: 3.No external corrosion? 1�'Yes O No 0 N/A
1.In normal(open or closed ition? RrYes 0 No 0 N/A 4.Properly aligned? OYes O No 0 N/A
2.Sealed,locked pervis 0Yes ONO 0 N/A 5.No external loads? dYes 0 No O N/A
3.Accessible? gryCS 0 No 0 N/A C.Visible pipe hangers and seismic braces not damaged or loose?
C.Isolation valves on backflow prevention assemblies in open FdrYes 0 No 0 N/A
position? O Yes ❑No U(N/A D.Adequate heat available to areas where wet sprinkler piping is
4.Monthly Inspection Items located?(Must be done before cold weather.)XYes ❑No O N/A
A.Proper number and type of spare sprinklers? Yes 0 No 0 N/A . 7.Annual,or every fifth year for valves which can be reset without
B.Sprinkler wrench with spare sprinklers? Q6cs ❑No O N/A opening:
C.Gauges on wet-pipe system in good condition and showing normal Interior of dry-pipe,preaction and deluge valves passed internal
water supply pressure? Yes ONO O N/A inspection? 0 Yes 0 No JdN/A
D.Alarm devices free from physical damage and all electrical 8.Fifth Year Inspection Items
connections secure? XYes O No 0 N/A A.Alarm valves and their associated strainers,filters and restriction
E.Alarm Valves: orifices passed internal inspection? 0 Yes O No VN/A
1.Gauges indicating normal supply water pressure?OYes O No N/A B.Check valves internally inspected and all parts operate properly,
2.Free from physical damage? 0 Yes ❑No UN/A move freely and are in good condition? O Yes 0 No Jff N/A
3.Valves in appropriate(open or closed)position?OYes 0 No ;rN/A C.Strainers,filters,restricted orifices and diaphragm chambers on
4.No leakage from retarding chamber or alarm drains? dry-pipe, preaction and deluge valves passed internal inspecti n?
0 Yes 0 No 0 N/A O Yes O No;d N/A
S E N T It Y FIRE PROTECTION INC.
4439 Hwy_12 SW, P.O. Box 69 Waverly, Minnesota 55390 763-658-4483 Fax#: 763-658-4921
B.Tett C.Msintenaect Sheet 2 of 2
The fallowing tests we to be performed at the noted intervals. Report 1.Regular Maintenance Items
my tam on Part III of this form. A.If sprinklers have been nplaccd,wee they proper rc0W nents?
1.Quarterly Tesla O Yes O No WN/A
A.
Sprinkler system main 1.Record Static Ptessnte� t and Residual Pressure � B.Air
���-�����m pre�ae ba mere than
P6 psi• psitw repaired? O Yes O No Wl/A
Rias flow observed'! RrYes O No (3 N/A C.Dry-pipe systems being maintained in dry condition?
2.An results comparable to previous test? , Yes O No O N/A O Yes O NoQTI/A
B.Waterflow alum devices passed tests? OCes O No O N/A D.If any of the following were discovered,was an obstruction
1.)orpectors test connection opened?(wet-pi)e when not in investigation conducted and the system flushed?O Yes O No)EN/A
fi wzipg weatber) Yes O No O N/A Fxplain reason(s)and obstruction imwestigadm findings in Part III
2.Bypass connection opened?(wet-pipe systems in f wzing 1.Defective intake screen for pumps talking suction fian open sources.
weather,dry-pipe,preaction.or deluge). O Yes O No Wl/A 2.Obstructive material discharged during waterflow tests.
3.Alamos actuated? AfYes O No O N/A 3.Foreign materials found in dry-pipe valves.check valves or pumps.
4.Was flow observed? A*Yes O No O N/A 4.Heavy discoloration of water during drain test or plugging of
C Comad Valves(except OS&Y and gear-operated indicating inspectors test eomnectiom
butterfly valves)opened until spring or torsion is felt in the rod, 5.Plugging of sprinkles found during activation or alteration.
thea closed back one-quarter turn? Yes O No O N/A 6.Plugging found in piping dismantled during alteatians.
D.Priming water level passed test in dry-pipe and preacdon systems? 7.Faihre to flush yard piping or surrounding public mains following
O Yes O NoA N/A new installation or repairs.
E Low air pressure signal an dry-pipe and preaction systems passed 8.Record of brokem mains in the vicinity.
test? O Yes O No WN/A 9.Abnormally frequent false-tripping of dry-pipe valves.
L Semiannual Test 10.System is retmmed to service after an extended period out of
Quick opening devices passed test? O Yes O No RNA service(greater than one yew).
3.Anand Tests 11.There is reason to believe the system contains sodium silicate
A.Are all sprinkles in service dated 1920 or later%dVcs O No O N/A or its derivatives.
B.Fast Response sprinklers in service for less than 20 years? 2.Annual Maintenance Items
If'no'test scrapie now and everyl0 years. O Yes O No jl N/A A.Operating stem of all OS&Y valves lubricated,completely closed,
C Standard sprb*kn in service for less than 50 years? and reopened? O Yes O No WN/A
If'no'test sample now and every IO years. .dYes O No O N/A B.Interior of dry-pipe,preaction and deluge valves cleaned?
D.Specific gravity of antifreeae correct? ArYes O No O N/A O Yes O No RMA
E All control valves operated through full range and returned to C.Low points draimcd in dry-pipe.preaCbon and deluge systems prior
normal position? Q(Yes O No O N/A to the onset of frorzing weather? O Yes O No.AW A
F.Preaction and deluge valves full flow trip test:(except deluge valves D.Sprinklers and spray nodes protecting commercial cooking
when water can't be dischaged) egnipmeu and ventilating systans replaced except for bulb-type
(Be sure to test all systans at the some time which arIdesigned which show no signs of grease buildup? O Yes O Nop'N/A
apowe surrtdWnaoasly in case of fire.) Part III-Comments (Any-bw answers,test failures or other
1.Water Som all nozzles unimpeded? O YN/A problems foul with the sprinkler system must be explained here.)
2 Ptesare at hydraulically most remote nozz3.Residual reading at valve psi.
Was flow ❑Y /A
4.Are above oompaabk to design values. N/A
5.Manual activation passed test? es O No O N/A
6.Automatic air aintenance devices ed test?
❑Yes O No O N/A
G.Dry-pipe valve partial flo trip test:
1.Record initial air pressure ps' water pressure psi.
2 Record tripping air pressure psi and tripping times(sec.).
3.Are above results oornpaatile previous tests?OYes OrioON/A
H.Automatic aQ maintenance derv' on dry-pipe and pmaction
systems passed test? O Yes O No O N/A
I. Backflow devices passed ow ? O Yes O No O N/A
L Backflow devices full flow test O Yes O No O N/A
K Allsprinkler pressure g control ves passed frill flow
est? O Yes O No O N/A
4.Dry-pipe fbB trip test to be done eve third year.
1.Record initial pr ssere psi and water ssure psi. N t IV-:pedO 'S fol'mum n
2 R000rd air posture psi and tripp' time '
3.Was water to inspectors test connection Yes Olio ON/A baps' Compa<
4.An above co mpwable to previous tests?O es O No O N/A Company's Address:
S.Tests b dome every flRh year. I state that the informatuan on this farm is correct at the time and place
A.Extra Very Extra High and Ultra High Tem sprinkles of my inspection.and that all equipment tested at this time was left in
O Yes No Ll N/A operaional condition upon completion of this inspection except as
B.Ganges checked against calibrated gauge or replaced? \ noted in Part III
O Yes O No O N/A
Signature of Dau:
Farm for Inspection,Testing and Maintenance of Fire Pumps ---
(0
Information on this form covers the minimum requirements of NFPA 25-1995 for centrifugal fie pumps. Separate forms wssoorw�
are available to inspect,test and maintain the rest of the fire protection system of which the fire pump is a part More
frequent inspection,testing and maintenance may be necessary depending on the conditions of the occupancy and water supply.
PP Y•
Owner: �/VO S p SC-A/00L
Owner's Address: e z
Property Being Inspected:
Property Address:
Date of Inspection: _t9
This inspection is(check one) O Weekly O Monthly O Quarterly O Semiannual Ak Annual
Note: All questions are to be answered Yes,No or Not Applicable. All"No"answers are to be explained in the comments portion of this form.
All responses refer to the current inspection performed on the date shown above.
' B. Tests
Bre �yRrasp:' 1. Weekly Test Items
j
A. Electric Motor-driven Pumps
011 e 1. Pump started automatically? _715- O p&Yes O No N/A
j• IF.W M .• '.
oeitaiTarntri, Record starting pressure."•' trv��.�-.� .., •a.ti R'.;..;, sure. Psi.
r+ ` 2. Pump rut for at least 10 minutes?.
Yes O No O N/A
tee
tv�i/t P Record suctionl and discharge�G pressure while naming.
<, 3. Pump Packing gland showing slight discharge?
or svpenarttetiva t t�atne �
Adjust if necessary.
Ayes O No O N/A
'^
Seettola � C1,r�•r�nf . s6q• 4. Free from unusual noises or vibrations? Yes No O N/A
� ns actor s '� "r' < ?l t., _ 5. Packing boxes,bearings and pump casing free from overheating?
A. Inspections-All to be performed weekly. AC-Yes O No O N/A
1. Pump houseroom at least 40"F? 49 Yes O No ❑ N/A 6. Record time for motor to accelerate to full speed, l 3
2. Pump house/room for diesels without engine heaters at least 70°F? 7. For reduced voltage or reduced current starting.record time
0 Yes 0 Noe$N/A controller is on first step.
3. Ventilating louvers free to operate? ❑ Yes O No 4K.N/A 8. For automatic stop controllers,record time pump nuns after
4. Suction,discharge and bypass valves open? WrYes O No O'N/A starting. ' ^-%%A!
5. Piping free from leaks? W Yes 0 No O N/A 9.All times and pressures in Part A acceptable?A Yes❑No❑ N/A
6. Suction and system pressure gauges normal? Yes O No O N/A B. Diesel Engine-Driven Pumps
7. Suction reservoir,if provided,full? fiT-Yes 0 No O N/A I- Pump started automatically? ❑ Yes O Nos N/A
8. Controller indicating power on? V Y'Yes ❑ No ❑ N/A Record starting pressure. psi.
9. Transfer switch indicating normal situation? V*%s ❑ No 0 N/A 2, Pump run for at least 30 minutes? (3 Yes O NajWN/A
10. Isolation switch closed? C'Yes O No O N/A
11. Reverse phase alarm indicator off or Record suction and discharge pressure whileHoming.
normal phase rotation indicator on? 90 Yes O No 0 N/A 3• Pump Peng gland showing slight discharge?0 Yes O No I N/A
12. Oil level in vertical motor sight normal? ❑ Yes 0 NoP4 N/A Adjust if necessary-
13. Diesel Engine Inspection 4. Free from unusual noises or vibrations? 0 Yes 0 No4N/A
a. Fuel tank at least two thirds full? O Yes O Nog N/A S. Packing boxes,bearings and pump casing free from overheating
b. Controller selector switch in Auto position?O Yes O NoCk N/A 0 Yes O Nod1Z4/A
c. Battery voltage and readings normal? O Yes O No A!f-N/A 6• Record time for engine to crank.
d. Battery charging current readings normal? O Yes O No ffN/A 7• Record time for engine to reach running ring speed•
e. Battery indicators on or failure indicators off?0 Yes O Noa&N/A 8. Engine oil pressure gauge,speed indicator,water and oil
f. All alarm indicators off? O Yes O No$"/A temperature indicators all reading normal? O Yes O No,Q N/A
9. Cooling water flowing from heat exchanger? O Yes 0 No p,: A
g. Record engine running time meter reading. Is this 10.All times and pressures in Part B acceptable?O Yes 0 No AK'N/A
appropriately higher than previous reading?O Yes O No l0.N/A C. Steam Turbine-driven Pumps
h. Oil level in right angle gear drive normal? O Yes O NoJ05,N/A 1• Record pump starting pressure ,strction and
i. Crankcase oil level normal? O Yes ❑ No 0"V/A
j. Cooling water level normal? O Yes ❑ No OLN/A discharge pressures while naming.
k. Electrolyte level in batteries normal? O Yes O No dJKN/A 3. Pump packing gland showing slight discharge?O Yes 0 No 91�N/A
1, Battery terminals free from corrosion? O Yes O NoO/A Adjust if necessary.
m. Water jacket heater operong? 0 Yes 0 No N/A 4. Free from unusual noises or vibrations? O Yes 0 No 44 N/A
14. Steam pressure gauge for steam driven pump reading normal? 5. Packing boxes,bearings and pump casing free from overheating)
O Yes 0 No'dN/A O Yes O No^\N/A
15. Circulation relief valve flowing water while pump chums? 6. Record steamressure
P Barge reading.
jd Yes 0 No O N/A 7. Record time for turbine to reach naming speed.
16. Pressure relief valves operating with proper pressure downstream 8. All times and pressures in Part C acceptable?O Yes O No 4T N/A
while pump is operational? 4:8,Yes 0 No O N/A
01994 National Fire Sprinkler Association, P.O. Box 1000,Patterson,NY 12563(914)878-4200 Used by permission. Form 25-20 Sheet I oft
2.' Annual Tests 2. Monthly Maintenance Items
Annual pump test was run using the following method:(check one) A. Isolation switch and circuit breaker exercised?&Yes O No G
B. Battery case clean.dry and free of corrosion? 0 Yes 0 No O N
�ethod A. Discharge of flow through hose streams. C. Batt ' s specific gravity or sta/rin
arge p d test?
Flow readings taken at each hose stream. ❑ Yes ❑ No 0 N/A
O Method B. Discharge through by-pass flow meter to drain or D. Charge and charge rate passed ins tion?O Yes O No 0 N/A
suction reservoir. Flow readings taken by flow meter. E. Battery c arge being equalizeds No 0 N/A
0 Method C. Discharge through by-pass flow meter directly F. Circuit b ers cleaned? 0 Yo N/A
returned to pump suction. Flow readings taken by flow meter. 3. Quarterly aintenance Items
Note: At least once every three years method A or B must be used A. Cleaned stray er,filter or dirt lel fuel system?
Pump Test Restilts 0 Yes O No N/A
No Flow Rated Flow Peak Flow B. Cleaned or reply ed crank case r in lubrication system?
Suction 0 Yes 0 No ❑ /A
Pressure C. Cleaned water s er in coolam? O Yes 0 No 0 N/A
Disc e / D. Insulation acce tabl and fire heliminated from exhaust
Pressure ` system? O Yes O N O N/A
Flow N/A E. Battery terminals clean d tighes O No 0 N/A
F. Electrical system free o wire ch0 Yes ❑ No O N/A
Electric Voltage N/A 4. Semi Annual Maintenan a Items
and Current A. Manual starting means on lectrical systems operated?
Pump Ck Yes 0 No 0 N/A
Speed B. Antifreeze tested in coolant s tem? O Yes 0 No a N/A
Are e values in e a ve to a—acceptable? es ❑ o O A C• Flexible exhaust section acc ble? 0 Yes O No ( N/A
No-flow(churn)test run for 30 min?�Yes O No ❑ N/A D. Alarms operated on electric 1 pions of diesel engine systems?
Circulation relief valve and pressure relief valve operated properly 0 Yes O No A N/A
during all flow tests?AYes O No 0 N/A E. Boxes,panels and cabinet on ele rical systems cleaned?
No alarm indicators or other visible abnormalities observed during V Yes ❑ No ❑ N/A
no flow test? `Yes ❑ No O N/A 5. Annual Maintenance It ms
D. Low Suction Throttling Device Test A. Changed pump bearing ubrication? Yes ❑ No til N/A
1. Low suction pressure simulated? 4!f-Yes 0 o O N/A B. Shaft end play accepts le? 0 Yes O No 14 N/A
Free from abnormalities in throttling action?�es O No 0 N/A C. Pump coupling align ent acceptable? l� Yes O No ❑ N/A
2. Free from abnormalities in return to full flow$Yes O No❑N/A D. Transmission coupli ,right angle ge drive and mechanical moving
E. Automatic Transfer Switch Test parts lubricated? ❑ es O No 9 N/A
1. Power failure simulated during peak flow? 0 Yes O Nq;&N/A E. Circuit breakers pas ed trip test? Q Yes 0 No 0 N/A
Connection made to alternate power source? 0 Yes O NqO&N/A F. Emergency manual caning means operat without power?
2. After termination of simulated power failure did motor reconnect 0 Yes 0 No 'N /A
to the normal power source? O Yes O No06-N/A G. Electrical con nec ons secure?�R Yes 0 o 0 N/A
F. All Alarm Conditions Simulated?A "des ❑ No O N/A H. Pressure switch s tongs calibrated? ❑ Yes No N/A
All Alarms Operated',6--Yes O No O N/A I. Motor bearings g eased? 0 Yes 0 No 72 N
J. Fuel tank free of ater and foreign material? Yes 0 No M N/A
C. Maintenance K. Tank vents and vertlow pipes free of obstruct ns?QYes ONo ON/A
A maintenance schedule must be established in accordance with the L. Fuel piping ac ptable? ❑ Yes 0 No 'N N/A
manufacturers instructions. /n the absence of such a schedule, the M. Oil and filters changed in diesel systems? ❑ Y s O No �k N/A
following must be used: N. Antifreeze ch nged in coolant system? 0 Yes No V N/A
1. Weekly Maintenance Items for Diesel Engine Systems: O. Heater exch ger cleaned out? 0 Yes 0 No ft /A
A. Fuel tank level,tank float swi<1e solenoid v ve operation P. Duct work louvers(combustion air)acceptable? Yes 0 No QN/A
acceptable? O Yes ❑ No ❑ Q. Exhaust sy em free of back pressure? O Yes O o 11 N/A
B. Diesel fuel system free of watYes 0 o Cl N/A R. Exhaust system hangers and supports acceptable? Yes 0 No m N/A
C. Flexible hoses and connectorsand lant systems S. Control and power wirings tight? 0 Yes O No Cl /A
acceptable? O es O No ❑
D. Oil level and lu oil heater ae? ❑ Yes ❑ No O N/A Part III - Comments (any "no answers,test failure or other
E. Coolant level acce C e? 0 No ❑ N/Aproblemsfound with the fire pump must be explained here.)
F. Water pump for coolant s ting? 0 Yes O No 0 N/A
G. Jacket water heater for coo nacceptable?0 Yes 0 No 0 N/A
H. Exhaust system free leakages o O N/A
I. Drain condensate tra on exham operas al?
O Yes 0 No O N/A
J. Electrolyte level in batteries acceptable? O Yes O No ❑ N/A
K. Connections to electrical system acceptable? ❑Yes 0 No O N/A
Part IV - Inspeetor'�Information I certify that the information on this form is correct at the time and place
Vi4w,"., my inspection,and that all equipment tested at this time was left in
Inspector: operational condi[' n upon com IFtio of this inspection except as noted
Company: in Part III above
Company Address: W .S, Signature of Inspector
01992 National Fire Sprinkler Association.P.O.Box 1000,Patterson,NY 12563 7 —( 3 —0 A Form 25-20 Sheet 2 of 2