Att 4.pdf

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Inspection Summary

Customer Information

Name Overton Brooks

Building Information

Name Overton Brooks - Outbuildngs

Address 510 E Stoner Ave, Shreveport, LA, 71101

Contact Information

Name Paul Celli

Role Supervisor

E-Mail paul.celli@va.gov

Phone 3182726117

Account Information

Service Provider

Johnson Controls North America

Office Address

3691 Old Shed Road, Bossier City, LA 71111

Office Phone 318-655-9114

Office License

F186

Inspector Name

William “Andy” Rolen

Inspector License

LA - E25457 / Backflow - 20240991

Inspection Information

Start Date 08/12/2024

Date 08/17/2024

Inspection Type

Joint Commission

Work Order# 57425096, 57425098, 57425100, 57425102, 57425104, 57425106

Timezone GMT-05:00

Inspection Summary

The following Tests and Inspections have been covered in this inspection

EP 2 - Tamper Switches and Water Flow Devices

EP 9 - Sprinkler Systems Main Drain

EP 10 - Fire Department Water Supply Connections

NFPA 25

General Inspection Notes

1. Annual Fire Sprinkler Inspection - Green Tagged www.xaapbuildings.com

DEVICE DEFICIENCIES

No device deficiencies in this inspection.

INSPECTION RESULTS SUMMARY

CURRENT INSPECTION RESULTS PREVIOUS INSPECTION RESULTS

TEST PERFORMED DEVICE TYPE TOTAL PASSED FAILED CANNOT INSPECT % INSPECTED TOTAL

EP2 High Pressure Water Alarm Switch 1 1 0 0 100 1

EP2 Tamper Switch 7 7 0 0 100 7

EP2 Water Flow Switch 7 7 0 0 100 7

EP2 Water Motor Gong 2 2 0 0 100 2

EP9 Main Drain - Easy Riser or Shotgun Valve 6 6 0 0 100 6

EP9 Main Drain - Wet Pipe Valve 2 2 0 0 100 2

EP10 Fire Dept. Connection 7 7 0 0 100 7

NFPA 25 Antifreeze System 1 1 0 0 100 1

NFPA 25 Check Valve 9 9 0 0 100 9

NFPA 25 Control Valve 9 9 0 0 100 9

NFPA 25 Easy Riser or Shotgun System 6 6 0 0 100 6

NFPA 25 Gauge 16 16 0 0 100 16

NFPA 25 Hose Valve Outlet 7 7 0 0 100 7

NFPA 25 Inspectors Test Valve 7 7 0 0 100 7

NFPA 25 Low Point Drain 2 2 0 0 100 2

NFPA 25 Pressure Regulating Valve 1 1 0 0 100 1

NFPA 25 Standpipe System 1 1 0 0 100 1

NFPA 25 Wet System 3 3 0 0 100 3

TOTAL 94 94 0 0 100 94

TAMPER SWITCHES AND WATER FLOW DEVICES

CUSTOMER NAME: Overton Brooks

BUILDING NAME: Overton Brooks - Outbuildngs

BUILDING ADDRESS: 510 E Stoner Ave, Shreveport, LA, 71101

CONTACT NAME: Paul Celli

CONTACT E-MAIL: paul.celli@va.gov

CONTACT ROLE: Supervisor

CONTACT PHONE: 3182726117

SERVICE PROVIDER: Johnson Controls North America

OFFICE ADDRESS: 3691 Old Shed Road, Bossier City, LA 71111

OFFICE PHONE: 318-655-9114

OFFICE LICENSE: F186

INSPECTOR: William “Andy” Rolen

INSPECTOR LICENSE: LA - E25457 / Backflow - 20240991

INSPECTION START DATE: 08/12/2024

INSPECTION END DATE: 08/17/2024

WORK ORDER: 57425096, 57425098, 57425100, 57425102, 57425104, 57425106

TIMEZONE: GMT-05:00

INSPECTION RESULTS SUMMARY

CURRENT INSPECTION RESULTS PREVIOUS INSPECTION RESULTS

DEVICE TYPE INVENTORY COUNT PASSED FAILED CANNOT INSPECT % INSPECTED INVENTORY COUNT

Water Flow Switch 7 7 0 0 100 7

High Pressure Water Alarm Switch 1 1 0 0 100 1

Water Motor Gong 2 2 0 0 100 2

Tamper Switch 7 7 0 0 100 7

DEVICE DEFICIENCIES

No device deficiencies in this inspection.

RETIRED DEVICES

No retired devices in this inspection.

Element of Performance - EP-2 NFPA 72-2010: Table 14.4.5 and NFPA 25-2011: Table 5.1.1.2

Joint Commission Standard EC.02.03.05 Element of Performance 2 EP -2

9ee2a713-2681-49ec-aa72-7093a816ae41 | Tamper Switches and Water Flow Devices | 08/17/2024

Customer: Overton Brooks | Building: Overton Brooks - Outbuildngs

Elements of Performance #2

At least semi-annually, the facility tests water-flow devices and at least semi-annually the facility tests supervisory valve tamper switches. The completion date of the tests is documented.

Valve Tamper Switches and Water Flow devices

For additional guidance on performing tests, see NFPA 72-2010: Table 14.4.5 and NFPA 25-2011: Table 5.1.1.2

Device Test Method

Control Valve Tamper Switch:

14.4.2.2-14.(i).(1)

Valve shall be operated and signal receipt shall be verified to be within the first two revolutions of the hand wheel or within one-fifth of the travel distance, or per the manufacture's specifications

Mechanical, Electro-sonic, or Pressure-Type Water flow Device:

14.4.2.2-14.(j)

Water shall be flowed through an inspector's test connection indicating the flow of water equal to that from a single sprinkler of the smallest orifice size in the system for wet-pipe systems, or an alarm test bypass connection for dry-pipe, pre-action, or deluge systems in accordance with NFPA 25.

A.1.1.1.2 There are times when a single inspection or test can meet the requirements of both NFPA 25 and NFPA 72 (e.g., operation of a tamper switch). This standard does not necessarily require that two separate inspections or tests be conducted on the same component, provided the inspection or test meets the requirements of both standards and the individual performing the inspection or test is qualified to perform the inspection or test required by both standards.

Element of Performance - EP-2 NFPA 72-2010: Table 14.4.5 and NFPA 25-2011: Table 5.1.1.2

Joint Commission Standard EC.02.03.05 Element of Performance 2 EP -2

9ee2a713-2681-49ec-aa72-7093a816ae41 | Tamper Switches and Water Flow Devices | 08/17/2024

WATER FLOW SWITCH

# LOCATION DESCRIPTION MAKE DEVICE TYPE BARCODE INSPECTOR DATE OF TEST RESULT

1 Building 55 Elevator shaft top sprinkler flow switch (above ceiling)

Water flow switch Water Flow Switch 287005580 Andy Rolen 08/16/2024 Passed

Quarterly Visual Inspection Only - Is flow switch free of damage with its electrical connections secure? Yes

What was the number of seconds that the water flow signal was delayed 15

Open test connection/bypass. Did water flow activate the alarm? Yes

2 Building 57 Wet system water flow switch Water flow switch Water Flow Switch 287006206 Andy Rolen 08/16/2024 Passed

Quarterly Visual Inspection Only - Is flow switch free of damage with its electrical connections secure? Yes

What was the number of seconds that the water flow signal was delayed 20

Open test connection/bypass. Did water flow activate the alarm? Yes

3 Building 6 Wet system water flow switch Water flow switch Water Flow Switch 287006213 Ethan Williamson 08/16/2024 Passed

Quarterly Visual Inspection Only - Is flow switch free of damage with its electrical connections secure? Yes

What was the number of seconds that the water flow signal was delayed 31

Open test connection/bypass. Did water flow activate the alarm? Yes

4 Building 16 Wet system water flow switch Water flow switch Water Flow Switch 287006222 Andy Rolen 08/16/2024 Passed

Quarterly Visual Inspection Only - Is flow switch free of damage with its electrical connections secure? Yes

What was the number of seconds that the water flow signal was delayed 15

Open test connection/bypass. Did water flow activate the alarm? Yes

5 Building 42 Wet system water flow switch Water flow switch Water Flow Switch 287013410 Andy Rolen 08/16/2024 Passed

Quarterly Visual Inspection Only - Is flow switch free of damage with its electrical connections secure? Yes

What was the number of seconds that the water flow signal was delayed 15

Open test connection/bypass. Did water flow activate the alarm? Yes

6 Building 4 Wet system water flow switch (room

4-17) Water flow switch Water Flow Switch 287005553 Andy Rolen 08/16/2024 Passed

Quarterly Visual Inspection Only - Is flow switch free of damage with its electrical connections secure? Yes

What was the number of seconds that the water flow signal was delayed 20

Open test connection/bypass. Did water flow activate the alarm? Yes

7 Building 33 Wet system water flow switch (room

111) Water flow switch Water Flow Switch 287005561 Andy Rolen 08/16/2024 Passed

Quarterly Visual Inspection Only - Is flow switch free of damage with its electrical connections secure? Yes

What was the number of seconds that the water flow signal was delayed 15

Open test connection/bypass. Did water flow activate the alarm? Yes

TAMPER SWITCH

# LOCATION DESCRIPTION MAKE DEVICE TYPE BARCODE INSPECTOR DATE OF TEST RESULT

1 Building 55

Elevator shaft top sprinkler valve tamper switch (above ceiling)

Tamper switch Tamper Switch 287005581 Andy Rolen 08/16/2024 Passed

Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes

2 Building 55 Supply test valve tamper switch Tamper switch Tamper Switch 287005576 Andy Rolen 08/16/2024 Passed

Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes

Element of Performance - EP-2 NFPA 72-2010: Table 14.4.5 and NFPA 25-2011: Table 5.1.1.2

Joint Commission Standard EC.02.03.05 Element of Performance 2 EP -2

9ee2a713-2681-49ec-aa72-7093a816ae41 | Tamper Switches and Water Flow Devices | 08/17/2024

TAMPER SWITCH

3 Building 2 Wet system control valve tamper switch

Snap switch Tamper Switch 287005544 Andy Rolen 08/16/2024 Passed

Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes

4 Building 55 Wet system control valve tamper switch

Tamper switch Tamper Switch 287005574 Andy Rolen 08/16/2024 Passed

Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes

5 Building 57 Wet system control valve tamper switch

Tamper switch Tamper Switch 287005582 Andy Rolen 08/16/2024 Passed

Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes

6 Building 42 Wet system control valve tamper switch

Tamper switch Tamper Switch 287006230 Andy Rolen 08/16/2024 Passed

Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes

7 Building 33 Wet system control valve tamper switch

(room 111) Tamper switch Tamper Switch 287005560 Andy Rolen 08/16/2024 Passed

Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes

WATER MOTOR GONG

# LOCATION DESCRIPTION MAKE DEVICE TYPE BARCODE INSPECTOR DATE OF TEST RESULT

1 Building 55 Water motor alarm Water motor alarm Water Motor Gong 287005572 Andy Rolen 08/16/2024 Passed

Water Motor Alarm Test Valve Closed? Yes

Water Motor Alarm Leak Tight? Yes

Visual Inspection – Is Water Motor Alarm Free of Damage? Yes

Open test connection/bypass. Did water flow activate the alarm? Yes

Is exterior alarm operational? Yes

2 Building 33 Wet system water motor alarm (room 111)

Water motor alarm Water Motor Gong 287005565 Andy Rolen 08/16/2024 Passed

Water Motor Alarm Test Valve Closed? Yes

Water Motor Alarm Leak Tight? Yes

Visual Inspection – Is Water Motor Alarm Free of Damage? Yes

Open test connection/bypass. Did water flow activate the alarm? Yes

HIGH PRESSURE WATER ALARM SWITCH

# LOCATION DESCRIPTION MAKE DEVICE TYPE BARCODE INSPECTOR DATE OF TEST RESULT

1 Building 55 Wet system water flow pressure switch Water pressure switch High Pressure Water

Alarm Switch 287005569 Andy Rolen 08/16/2024 Passed

Quarterly Visual Inspection Only - Is flow switch free of damage with its electrical connections secure? Yes

Inspector Signature

Inspector Name William “Andy” Rolen Date 08/17/2024

Element of Performance - EP-2 NFPA 72-2010: Table 14.4.5 and NFPA 25-2011: Table 5.1.1.2

Joint Commission Standard EC.02.03.05 Element of Performance 2 EP -2

9ee2a713-2681-49ec-aa72-7093a816ae41 | Tamper Switches and Water Flow Devices | 08/17/2024

SPRINKLER SYSTEMS MAIN DRAIN

BUILDING NAME: Overton Brooks - Outbuildngs

BUILDING ADDRESS: 510 E Stoner Ave, Shreveport, LA, 71101

CONTACT NAME: Paul Celli

CONTACT E-MAIL: paul.celli@va.gov

CONTACT ROLE: Supervisor

CONTACT PHONE: 3182726117

SERVICE PROVIDER: Johnson Controls North America

OFFICE ADDRESS: 3691 Old Shed Road, Bossier City, LA 71111

OFFICE PHONE: 318-655-9114

OFFICE LICENSE: F186

INSPECTOR: William “Andy” Rolen

INSPECTOR LICENSE: LA - E25457 / Backflow - 20240991

INSPECTION START DATE: 08/12/2024

INSPECTION END DATE: 08/17/2024

WORK ORDER: 57425096, 57425098, 57425100, 57425102, 57425104, 57425106

TIMEZONE: GMT-05:00

INSPECTION RESULTS SUMMARY

CURRENT INSPECTION RESULTS PREVIOUS INSPECTION RESULTS

DEVICE TYPE INVENTORY COUNT PASSED FAILED CANNOT INSPECT % INSPECTED INVENTORY COUNT

Main Drain - Wet Pipe Valve 2 2 0 0 100 2

Main Drain - Easy Riser or Shotgun Valve 6 6 0 0 100 6

DEVICE DEFICIENCIES

No device deficiencies in this inspection.

RETIRED DEVICES

No retired devices in this inspection.

Element of Performance - EP-9 NFPA 25-2011: 13.2.5; 13.3.3.4; Table 13.1.1.2; Table 13.8.1

Joint Commission Standard EC.02.03.05 Element of Performance 9 EP -9

9ee2a713-2681-49ec-aa72-7093a816ae41 | Sprinkler Systems Main Drain | 08/17/2024

Elements of Performance #9

Every 12 months the facility tests the main drains at the system low point or at all system risers. A main drain test shall be conducted annually at each system riser and any time the valve is closed at each system riser or feed main after the control valve has been closed to determine whether there has been a change in the condition of the water supply piping and control valves. The completion date of the tests is documented.

Main Drain

For additional guidance on performing the annual / quarterly tests, see NFPA 25-2011: 13.2.5; 13.3.3.4; Table 13.1.1.2; Table 13.8.1

Device Test Method

Main Drain 1. Record the pressure indicated by the supply water gauge.

2. Close the alarm control valve on alarm valves.

3. Fully open the main drain valve.

4. After the flow has stabilized, record the residual (flowing) pressure indicated by the water supply gauge.

5. Close the main drain valve slowly.

6. Record the time taken for the supply water pressure to return to the original static (non-flowing) pressure.

7. Open the alarm control valve.

** 13.2.5.1 In systems where the sole water supply is through a backflow preventer and/or pressure reducing valves, the main drain test of at least one system downstream of the device shall be conducted on a quarterly basis.

Element of Performance - EP-9 NFPA 25-2011: 13.2.5; 13.3.3.4; Table 13.1.1.2; Table 13.8.1

Joint Commission Standard EC.02.03.05 Element of Performance 9 EP -9

9ee2a713-2681-49ec-aa72-7093a816ae41 | Sprinkler Systems Main Drain | 08/17/2024

MAIN DRAIN - WET PIPE VALVE

1 Building 2 Main drain test Gate valve Main Drain - Wet

Pipe Valve 287005545 Andy Rolen 08/16/2024 Passed

Test Pipe Located? Riser

Size of Test Pipe? 2”

Previous Main Drain Test Date 08/25/2023

Previous Main Drain Static Pressure 175

Previous Main Drain Residual Pressure 168

Static Supply Pressure? 160

Residual Pressure? 150

Time to return to Normal System Pressure? 1 second

Static Pressure after completion of test? 160

Main Drain-PSI Comparable Yes

Main drain opened & free of obstruction discoloration? Yes

2 Building 55 Main drain test Gate valve Main Drain - Wet

Pipe Valve 287005577 Andy Rolen 08/16/2024 Passed

Test Pipe Located? Riser

Size of Test Pipe? 1.25

Previous Main Drain Test Date 08/25/2023

Previous Main Drain Static Pressure 175

Previous Main Drain Residual Pressure 167

Static Supply Pressure? 190

Residual Pressure? 175

Time to return to Normal System Pressure? 1 second

Static Pressure after completion of test? 190

Main Drain-PSI Comparable Yes

Main drain opened & free of obstruction discoloration? Yes

MAIN DRAIN - EASY RISER OR SHOTGUN VALVE

# LOCATION DESCRIPTION MAKE DEVICE TYPE BARCODE INSPECTOR DATE OF TEST RESULT

1 Building 57 Main drain test Gate valve Main Drain - Easy Riser or Shotgun

Valve 287006209 Andy Rolen 08/16/2024 Passed

Test Pipe Located? Riser

Size of Test Pipe? 1.5

Previous Main Drain Test Date 08/25/2023

Previous Main Drain Static Pressure 150

Previous Main Drain Residual Pressure 140

Static Supply Pressure? 160

Residual Pressure? 150

Time to return to Normal System Pressure? 1 second

Static Pressure after completion of test? 150

Element of Performance - EP-9 NFPA 25-2011: 13.2.5; 13.3.3.4; Table 13.1.1.2; Table 13.8.1

Joint Commission Standard EC.02.03.05 Element of Performance 9 EP -9

9ee2a713-2681-49ec-aa72-7093a816ae41 | Sprinkler Systems Main Drain | 08/17/2024

MAIN DRAIN - EASY RISER OR SHOTGUN VALVE

2 Building 6 Main drain test Gate Main Drain - Easy Riser or Shotgun

Valve 287006216 Ethan Williamson 08/16/2024 Passed

Test Pipe Located? Riser

Size of Test Pipe? 1.25

Previous Main Drain Test Date 11/15/2022

Previous Main Drain Static Pressure 176

Previous Main Drain Residual Pressure 167

Static Supply Pressure? 175

Residual Pressure? 162

Time to return to Normal System Pressure? 1 second

Static Pressure after completion of test? 175

3 Building 16 Main drain test Gate valve Main Drain - Easy Riser or Shotgun

Valve 287006225 Andy Rolen 08/16/2024 Passed

Test Pipe Located? Riser

Size of Test Pipe? 1.25

Previous Main Drain Test Date 08/25/2023

Previous Main Drain Static Pressure 174

Previous Main Drain Residual Pressure 169

Static Supply Pressure? 170

Residual Pressure? 160

Time to return to Normal System Pressure? 1 second

Static Pressure after completion of test? 170

Main Drain-PSI Comparable Yes

Main drain opened & free of obstruction discoloration? Yes

4 Building 42 Main drain test Gate valve Main Drain - Easy Riser or Shotgun

Valve 287006231 Andy Rolen 08/16/2024 Passed

Test Pipe Located? Riser

Size of Test Pipe? 1”

Previous Main Drain Test Date 08/25/2023

Previous Main Drain Static Pressure 177

Previous Main Drain Residual Pressure 167

Static Supply Pressure? 175

Residual Pressure? 169

Time to return to Normal System Pressure? 1 second

Static Pressure after completion of test? 174

Main Drain-PSI Comparable Yes

Element of Performance - EP-9 NFPA 25-2011: 13.2.5; 13.3.3.4; Table 13.1.1.2; Table 13.8.1

Joint Commission Standard EC.02.03.05 Element of Performance 9 EP -9

9ee2a713-2681-49ec-aa72-7093a816ae41 | Sprinkler Systems Main Drain | 08/17/2024

MAIN DRAIN - EASY RISER OR SHOTGUN VALVE

5 Building 4 Main drain test

(room 4-17) Angle gate valve

Main Drain - Easy Riser or Shotgun

Valve 287005555 Andy Rolen 08/16/2024 Passed

Test Pipe Located? Riser

Size of Test Pipe? 1.5

Previous Main Drain Test Date 08/25/2023

Previous Main Drain Static Pressure 176

Previous Main Drain Residual Pressure 167

Static Supply Pressure? 175

Residual Pressure? 168

Time to return to Normal System Pressure? 1 second

Static Pressure after completion of test? 176

Main Drain-PSI Comparable Yes

Main drain opened & free of obstruction discoloration? Yes

6 Building 33 Wet system main drain Gate valve

Main Drain - Easy Riser or Shotgun

Valve 287005563 Andy Rolen 08/16/2024 Passed

Test Pipe Located? Building 33

Size of Test Pipe? 2”

Previous Main Drain Test Date 08/25/2023

Inspector Signature

Inspector Name William “Andy” Rolen Date 08/17/2024

Element of Performance - EP-9 NFPA 25-2011: 13.2.5; 13.3.3.4; Table 13.1.1.2; Table 13.8.1

Joint Commission Standard EC.02.03.05 Element of Performance 9 EP -9

9ee2a713-2681-49ec-aa72-7093a816ae41 | Sprinkler Systems Main Drain | 08/17/2024

FIRE DEPARTMENT WATER SUPPLY CONNECTIONS

BUILDING NAME: Overton Brooks - Outbuildngs

BUILDING ADDRESS: 510 E Stoner Ave, Shreveport, LA, 71101

CONTACT NAME: Paul Celli

CONTACT E-MAIL: paul.celli@va.gov

CONTACT ROLE: Supervisor

CONTACT PHONE: 3182726117

SERVICE PROVIDER: Johnson Controls North America

OFFICE ADDRESS: 3691 Old Shed Road, Bossier City, LA 71111

OFFICE PHONE: 318-655-9114

OFFICE LICENSE: F186

INSPECTOR: William “Andy” Rolen

INSPECTOR LICENSE: LA - E25457 / Backflow - 20240991

INSPECTION START DATE: 08/12/2024

INSPECTION END DATE: 08/17/2024

WORK ORDER: 57425096, 57425098, 57425100, 57425102, 57425104, 57425106

TIMEZONE: GMT-05:00

INSPECTION RESULTS SUMMARY

CURRENT INSPECTION RESULTS PREVIOUS INSPECTION RESULTS

DEVICE TYPE INVENTORY COUNT PASSED FAILED CANNOT INSPECT % INSPECTED INVENTORY COUNT

Fire Dept. Connection 7 7 0 0 100 7

DEVICE DEFICIENCIES

No device deficiencies in this inspection.

RETIRED DEVICES

No retired devices in this inspection.

Element of Performance - EP-10 NFPA 25-2011: 13.7; Table 13.1.1.2

Joint Commission Standard EC.02.03.05 Element of Performance 10 EP -1

9ee2a713-2681-49ec-aa72-7093a816ae41 | Fire Department Water Supply Connections | 08/17/2024

Elements of Performance #10

Every quarter the facility inspects all fire department water supply connections. The completion date of the tests is documented.

Fire Department Connections

For additional guidance on performing the tests, see NFPA 25-2011: 13.7; Table 13.1.1.2

Device Test Method

Fire Department Connections

1. The fire department connections are visible and accessible.

2. Couplings or swivels are not damaged and rotate smoothly.

3. Plugs or caps are in place and undamaged.

4. Gaskets are in place and in good condition.

5. Identification signs are in place.

6. The check valve is not leaking.

7. The automatic drain valve is in place and operating properly.

8. The fire department connection clapper(s) is in place and operating properly.

Element of Performance - EP-10 NFPA 25-2011: 13.7; Table 13.1.1.2

Joint Commission Standard EC.02.03.05 Element of Performance 10 EP -1

9ee2a713-2681-49ec-aa72-7093a816ae41 | Fire Department Water Supply Connections | 08/17/2024

FIRE DEPT. CONNECTION

1 Parking garage FDC Standpipe FDC Fire Dept.

Connection 287006200 Andy Rolen 08/16/2024 Passed

FDC Quarterly Questions

Is FDC Visible / Accessible? Yes

Are Couplings / Swivels / Plugs / Caps in place? Yes

Identification Signs In Place? Yes

Check Valve Not Leaking / Gaskets In Good Condition / Ball Drip and Clapper in Place and Operating Properly Yes

FDC Hydrostatic Test Date 07/14/2023

FDC Check Valves Internal Inspection Date 07/14/2023

2 Building 4 FDC wet system FDC Fire Dept.

Connection 287005551 Andy Rolen 08/16/2024 Passed

FDC Quarterly Questions

Is FDC Visible / Accessible? Yes

Are Couplings / Swivels / Plugs / Caps in place? Yes

Identification Signs In Place? Yes

Check Valve Not Leaking / Gaskets In Good Condition / Ball Drip and Clapper in Place and Operating Properly Yes

FDC Hydrostatic Test Date 03/08/2021

FDC Check Valves Internal Inspection Date 03/23/2021

3 Building 55 FDC wet system FDC Fire Dept.

Connection 287005566 Andy Rolen 08/16/2024 Passed

FDC Quarterly Questions

Is FDC Visible / Accessible? Yes

Are Couplings / Swivels / Plugs / Caps in place? Yes

Identification Signs In Place? Yes

Check Valve Not Leaking / Gaskets In Good Condition / Ball Drip and Clapper in Place and Operating Properly Yes

FDC Hydrostatic Test Date 03/12/2021

FDC Check Valves Internal Inspection Date 03/12/2021

4 Building 57 FDC wet system FDC Fire Dept.

Connection 287005585 Andy Rolen 08/16/2024 Passed

FDC Quarterly Questions

Is FDC Visible / Accessible? Yes

Are Couplings / Swivels / Plugs / Caps in place? Yes

Identification Signs In Place? Yes

Check Valve Not Leaking / Gaskets In Good Condition / Ball Drip and Clapper in Place and Operating Properly Yes

FDC Hydrostatic Test Date 02/11/2021

FDC Check Valves Internal Inspection Date 02/11/2021

5 Building 6 FDC wet system FDC Fire Dept.

Connection 287006210 Ethan Williamson 08/16/2024 Passed

FDC Quarterly Questions

Is FDC Visible / Accessible? Yes

Are Couplings / Swivels / Plugs / Caps in place? Yes

Identification Signs In Place? Yes

Check Valve Not Leaking / Gaskets In Good Condition / Ball Drip and Clapper in Place and Operating Properly Yes

FDC Hydrostatic Test Date 02/11/2021

FDC Check Valves Internal Inspection Date 02/11/2021

Element of Performance - EP-10 NFPA 25-2011: 13.7; Table 13.1.1.2

Joint Commission Standard EC.02.03.05 Element of Performance 10 EP -1

9ee2a713-2681-49ec-aa72-7093a816ae41 | Fire Department Water Supply Connections | 08/17/2024

FIRE DEPT. CONNECTION

6 Building 16 FDC wet system FDC Fire Dept.

Connection 287006224 Andy Rolen 08/16/2024 Passed

FDC Quarterly Questions

Is FDC Visible / Accessible? Yes

Are Couplings / Swivels / Plugs / Caps in place? Yes

Identification Signs In Place? Yes

Check Valve Not Leaking / Gaskets In Good Condition / Ball Drip and Clapper in Place and Operating Properly Yes

FDC Hydrostatic Test Date 02/10/2021

FDC Check Valves Internal Inspection Date 02/10/2021

7 Building 2 FDC wet system

(Room 09-2)

FDC

Fire Dept.

Connection

287005548 Andy Rolen 08/16/2024 Passed

FDC Quarterly Questions

Is FDC Visible / Accessible? Yes

Are Couplings / Swivels / Plugs / Caps in place? Yes

Identification Signs In Place? Yes

Check Valve Not Leaking / Gaskets In Good Condition / Ball Drip and Clapper in Place and Operating Properly Yes

FDC Hydrostatic Test Date 03/12/2021

FDC Check Valves Internal Inspection Date 03/12/2021

Inspector Signature

Inspector Name William “Andy” Rolen Date 08/17/2024

Element of Performance - EP-10 NFPA 25-2011: 13.7; Table 13.1.1.2

Joint Commission Standard EC.02.03.05 Element of Performance 10 EP -1

9ee2a713-2681-49ec-aa72-7093a816ae41 | Fire Department Water Supply Connections | 08/17/2024

NFPA 25

BUILDING NAME: Overton Brooks - Outbuildngs

BUILDING ADDRESS: 510 E Stoner Ave, Shreveport, LA, 71101

CONTACT NAME: Paul Celli

CONTACT E-MAIL: paul.celli@va.gov

CONTACT ROLE: Supervisor

CONTACT PHONE: 3182726117

SERVICE PROVIDER: Johnson Controls North America

OFFICE ADDRESS: 3691 Old Shed Road, Bossier City, LA 71111

OFFICE PHONE: 318-655-9114

OFFICE LICENSE: F186

INSPECTOR: William “Andy” Rolen

INSPECTOR LICENSE: LA - E25457 / Backflow - 20240991

INSPECTION START DATE: 08/12/2024

INSPECTION END DATE: 08/17/2024

WORK ORDER: 57425096, 57425098, 57425100, 57425102, 57425104, 57425106

TIMEZONE: GMT-05:00

INSPECTION RESULTS SUMMARY

CURRENT INSPECTION RESULTS PREVIOUS INSPECTION RESULTS

DEVICE TYPE INVENTORY COUNT PASSED FAILED CANNOT INSPECT % INSPECTED INVENTORY COUNT

Antifreeze System 1 1 0 0 100 1

Check Valve 9 9 0 0 100 9

Control Valve 9 9 0 0 100 9

Easy Riser or Shotgun System 6 6 0 0 100 6

Gauge 16 16 0 0 100 16

Hose Valve Outlet 7 7 0 0 100 7

Inspectors Test Valve 7 7 0 0 100 7

Low Point Drain 2 2 0 0 100 2

Pressure Regulating Valve 1 1 0 0 100 1

Standpipe System 1 1 0 0 100 1

Wet System 3 3 0 0 100 3

DEVICE DEFICIENCIES

No device deficiencies in this inspection.

RETIRED DEVICES

No retired devices in this inspection.

NFPA 25, Edition 2011

N

FP

A

9ee2a713-2681-49ec-aa72-7093a816ae41 | NFPA 25 | 08/17/2024

CHECK VALVE

1 Building 6 Antifreeze loop check valve (room A-10)

Swing check Check Valve 287005999 Ethan Williamson 08/16/2024 Passed

What is the Size of this Check Valve 1.25

Annual Visual Inspection Pass

Date of 5 Year Internal Check Valve Inspection 02/11/2021

2 Building 55 FDC check valve Swing check Check Valve 287005567 Andy Rolen 08/16/2024 Passed

What is the Size of this Check Valve 4”

Annual Visual Inspection Pass

Was the 5 Year Internal Check Valve Inspection Completed During This Inspection No

Date of 5 Year Internal Check Valve Inspection 03/12/2021

3 Building 57 FDC check valve Swing check Check Valve 287005584 Andy Rolen 08/16/2024 Passed

What is the Size of this Check Valve 4”

Annual Visual Inspection Pass

Was the 5 Year Internal Check Valve Inspection Completed During This Inspection No

Date of 5 Year Internal Check Valve Inspection 02/11/2021

4 Building 6 FDC check valve Swing check Check Valve 287006212 Ethan Williamson 08/16/2024 Passed

What is the Size of this Check Valve 4”

Annual Visual Inspection Pass

Date of 5 Year Internal Check Valve Inspection 02/11/2021

5 Building 16 FDC check valve Wafer Check Check Valve 287006221 Andy Rolen 08/16/2024 Passed

What is the Size of this Check Valve 4”

Annual Visual Inspection Pass

Was the 5 Year Internal Check Valve Inspection Completed During This Inspection No

Date of 5 Year Internal Check Valve Inspection 02/10/2021

6 Building 4 FDC check valve

(room 4-17) Swing check Check Valve 287005552 Andy Rolen 08/16/2024 Passed

What is the Size of this Check Valve 4”

Annual Visual Inspection Pass

Was the 5 Year Internal Check Valve Inspection Completed During This Inspection No

Date of 5 Year Internal Check Valve Inspection 03/08/2021

7 Building 2 FDC check valve

(Room 09-2) Swing check Check Valve 287005549 Andy Rolen 08/16/2024 Passed

What is the Size of this Check Valve 4”

Annual Visual Inspection Pass

Was the 5 Year Internal Check Valve Inspection Completed During This Inspection No

Date of 5 Year Internal Check Valve Inspection 03/12/2021

8 Parking garage Standpipe FDC

Check Valve Swing check Check Valve 287006201 Andy Rolen 08/16/2024 Passed

What is the Size of this Check Valve 4”

Annual Visual Inspection Pass

Was the 5 Year Internal Check Valve Inspection Completed During This Inspection No

Date of 5 Year Internal Check Valve Inspection 12/31/2017

NFPA 25, Edition 2011

N

FP

A

9ee2a713-2681-49ec-aa72-7093a816ae41 | NFPA 25 | 08/17/2024

CHECK VALVE

9 Building 16 Wet system supply check valve Wafer Check Check Valve 287006220 Andy Rolen 08/16/2024 Passed

What is the Size of this Check Valve 4”

Annual Visual Inspection Pass

Was the 5 Year Internal Check Valve Inspection Completed During This Inspection No

Date of 5 Year Internal Check Valve Inspection 02/10/2021

ANTIFREEZE SYSTEM

# LOCATION DESCRIPTION MAKE DEVICE TYPE BARCODE INSPECTOR DATE OF TEST RESULT

1 Building 6 Antifreeze loop (room

A-10) PG Antifreeze System 287005969 Andy Rolen 08/16/2024 Passed

Size (In Gallons) 18

Antifreeze Information Sign Located on Antifreeze System Main Valve Yes

What Type of Antifreeze Solution is in the System PG

Is the antifreeze solution the correct type for the system piping? Yes

What is the antifreeze protection level (In Degrees) -26

Antifreeze Inspected and Tested Per NFPA 25 Yes

GAUGE

# LOCATION DESCRIPTION MAKE DEVICE TYPE BARCODE INSPECTOR DATE OF TEST RESULT

1 Building 6 Antifreeze loop supply gauge (room A-10)

Water gauge Gauge 287005967 Ethan Williamson 08/16/2024 Passed

Type of Gauge Water

Gauge Date 02/11/2021

2 Building 6 Antifreeze loop system gauge

(room A-10) Water gauge Gauge 287005968 Ethan Williamson 08/16/2024 Passed

Type of Gauge Water

Gauge Date 02/11/2021

3 Building 2 Wet system supply water gauge Water gauge Gauge 287005540 Andy Rolen 08/16/2024 Passed

Type of Gauge Water

Gauge Date 03/22/2021

4 Building 55 Wet system supply water gauge Water gauge Gauge 287005570 Andy Rolen 08/16/2024 Passed

Type of Gauge Water

Gauge Date 03/12/2021

5 Building 16 Wet system supply water gauge Water gauge Gauge 287006218 Andy Rolen 08/16/2024 Passed

Type of Gauge Water

Gauge Date 03/10/2021

6 Building 42 Wet system supply water gauge Water gauge Gauge 287006226 Andy Rolen 08/16/2024 Passed

Type of Gauge Water

Gauge Date 03/12/2021

NFPA 25, Edition 2011

N

FP

A

9ee2a713-2681-49ec-aa72-7093a816ae41 | NFPA 25 | 08/17/2024

GAUGE

7 Building 2 Wet system water gauge Water gauge Gauge 287005541 Andy Rolen 08/16/2024 Passed

Type of Gauge Water

Gauge Date 03/22/2021

8 Building 55 Wet system water gauge Water gauge Gauge 287005571 Andy Rolen 08/16/2024 Passed

Type of Gauge Water

Gauge Date 03/12/2021

9 Building 57 Wet system water gauge Water gauge Gauge 287006208 Andy Rolen 08/16/2024 Passed

Type of Gauge Water

Gauge Date 02/11/2021

10 Building 6 Wet system water gauge Water gauge Gauge 287006211 Ethan Williamson 08/16/2024 Passed

Type of Gauge Water

Gauge Date 02/11/2021

11 Building 16 Wet system water gauge Water gauge Gauge 287006219 Andy Rolen 08/16/2024 Passed

Type of Gauge Water

Gauge Date 02/10/2021

12 Building 42 Wet system water gauge Water gauge Gauge 287006227 Andy Rolen 08/16/2024 Passed

Type of Gauge Water

Gauge Date 03/12/2021

13 Building 4 Wet system water gauge (room 4-17)

Water gauge Gauge 287005554 Andy Rolen 08/16/2024 Passed

Type of Gauge Water

Gauge Date 03/08/2021

14 Building 3 Wet system water gauge (Room 09-2) Water gauge Gauge 287005072 Andy Rolen 08/16/2024 Passed

Type of Gauge Water

Gauge Date 03/12/2021

15 Building 33 Wet system water gauge (room 111)

Water gauge Gauge 287005558 Andy Rolen 08/16/2024 Passed

Type of Gauge Water

Gauge Date 02/10/2021

16 Building 33 Wet system water gauge (room 111)

Water gauge Gauge 287005559 Andy Rolen 08/16/2024 Passed

Type of Gauge Water

Gauge Date 02/10/2021

NFPA 25, Edition 2011

N

FP

A

9ee2a713-2681-49ec-aa72-7093a816ae41 | NFPA 25 | 08/17/2024

STANDPIPE SYSTEM

1 Parking garage Dry standpipe system.

Class 1 Standpipe System 287006202 Andy Rolen 08/16/2024 Passed

Is This a Wet or Dry Standpipe? Dry Standpipe

Define Type Of Standpipe Class 1 (2.5")

What Size Is This Valve? 2.5

Drains Leak Tight Yes

Building Free Of Conditions Exposing Pipe To Freezing Yes

Date of Last Standpipe System Flow Test 07/14/2023

Date of Check Valves Internal Inspection 07/14/2023

Date of Internal Inspection of Standpipe Valve Strainers, Filters, And Restriction Orifices. 07/14/2023

Date of Dry Pipe And Dry Portions Hydro Test 07/14/2023

Date of Gauges Replacement 07/14/2023

Date the internal pipe inspection was performed? 07/14/2023

* Due for a 5 year internal inspection

CONTROL VALVE

# LOCATION DESCRIPTION MAKE DEVICE TYPE BARCODE INSPECTOR DATE OF TEST RESULT

1 Building 55

Elevator shaft top sprinkler control valve (above ceiling)

Butterball Control Valve 287005579 Andy Rolen 08/16/2024 Passed

Is This A Main System, Sub System, Or Auxiliary Control Valve? Sub System

What Size Is This Control Valve? 1”

Easily Accessible? Yes

Signs? Yes

Valve in the Appropriate Open or Closed Position? Yes

Sealed, Locked, and/or Supervised Supervised

Free from External Leaks Yes

2 Building 2 Storage isolation control valve Osy Control Valve 287005547 Andy Rolen 08/16/2024 Passed

Is This A Main System, Sub System, Or Auxiliary Control Valve? Sectional

What Size Is This Control Valve? 2”

Easily Accessible? Yes

Signs? Yes

Valve in the Appropriate Open or Closed Position? Yes

Sealed, Locked, and/or Supervised Locked

Free from External Leaks Yes

Control Valve - Annual Questions

Control Valve Fully Exercised? Yes

NFPA 25, Edition 2011

N

FP

A

9ee2a713-2681-49ec-aa72-7093a816ae41 | NFPA 25 | 08/17/2024

CONTROL VALVE

3 Building 55 Supply test control valve Butterfly Control Valve 287005575 Andy Rolen 08/16/2024 Passed

Is This A Main System, Sub System, Or Auxiliary Control Valve? Main

What Size Is This Control Valve? 2.5”

Easily Accessible? Yes

Signs? Yes

Valve in the Appropriate Open or Closed Position? Yes

Sealed, Locked, and/or Supervised Supervised

Free from External Leaks Yes

4 Building 2 Wet system control valve Osy Control Valve 287005543 Andy Rolen 08/16/2024 Passed

Is This A Main System, Sub System, Or Auxiliary Control Valve? Main

What Size Is This Control Valve? 4”

Easily Accessible? Yes

Signs? Yes

Valve in the Appropriate Open or Closed Position? Yes

Sealed, Locked, and/or Supervised Locked

Free from External Leaks Yes

Control Valve - Annual Questions

Control Valve Fully Exercised? Yes

5 Building 55 Wet system control valve Osy Control Valve 287005573 Andy Rolen 08/16/2024 Passed

Is This A Main System, Sub System, Or Auxiliary Control Valve? Main

What Size Is This Control Valve? 2.5

Easily Accessible? Yes

Signs? Yes

Valve in the Appropriate Open or Closed Position? Yes

Sealed, Locked, and/or Supervised Supervised

Free from External Leaks Yes

6 Building 57 Wet system control valve Butterfly Control Valve 287005583 Andy Rolen 08/16/2024 Passed

Is This A Main System, Sub System, Or Auxiliary Control Valve? Main

What Size Is This Control Valve? 2.5”

Easily Accessible? Yes

Signs? Yes

Valve in the Appropriate Open or Closed Position? Yes

Sealed, Locked, and/or Supervised Supervised

Free from External Leaks Yes

Control Valve - Annual Questions

Control Valve Fully Exercised? Yes

NFPA 25, Edition 2011

N

FP

A

9ee2a713-2681-49ec-aa72-7093a816ae41 | NFPA 25 | 08/17/2024

CONTROL VALVE

7 Building 42 Wet system control valve Butterball Control Valve 287006229 Andy Rolen 08/16/2024 Passed

Is This A Main System, Sub System, Or Auxiliary Control Valve? Main

What Size Is This Control Valve? 2”

Easily Accessible? Yes

Signs? Yes

Valve in the Appropriate Open or Closed Position? Yes

Sealed, Locked, and/or Supervised Supervised

Free from External Leaks Yes

8 Building 3 Wet system control valve (Room 09-2)

Osy Control Valve 287005073 Andy Rolen 08/16/2024 Passed

Is This A Main System, Sub System, Or Auxiliary Control Valve? Sub System

What Size Is This Control Valve? 2.5

Easily Accessible? Yes

Signs? Yes

Valve in the Appropriate Open or Closed Position? Yes

Sealed, Locked, and/or Supervised Supervised

Free from External Leaks Yes

9 Building 33 Wet system control valve (room 111)

Osy Control Valve 287005562 Andy Rolen 08/16/2024 Passed

Is This A Main System, Sub System, Or Auxiliary Control Valve? Main

What Size Is This Control Valve? 4”

Easily Accessible? Yes

Signs? Yes

Valve in the Appropriate Open or Closed Position? Yes

Sealed, Locked, and/or Supervised Supervised

Free from External Leaks Yes

Control Valve - Annual Questions

Control Valve Fully Exercised? Yes

INSPECTORS TEST VALVE

# LOCATION DESCRIPTION MAKE DEVICE TYPE BARCODE INSPECTOR DATE OF TEST RESULT

1 Building 2 ITV wet system Gate valve Inspectors Test Valve 287005550 Andy Rolen 08/16/2024 Passed

Inspectors Test Valve Functional Test Yes

2 Building 55 ITV wet system Gate valve Inspectors Test Valve 287005568 Andy Rolen 08/16/2024 Passed

Inspectors Test Valve Functional Test Yes

3 Building 57 ITV wet system ITV Inspectors Test Valve 287006207 Andy Rolen 08/16/2024 Passed

Inspectors Test Valve Functional Test Yes

4 Building 6 ITV wet system Gate valve Inspectors Test Valve 287005998 Ethan Williamson 08/16/2024 Passed

Inspectors Test Valve Functional Test Yes

5 Building 16 ITV wet system Gate valve Inspectors Test Valve 287006217 Andy Rolen 08/16/2024 Passed

Inspectors Test Valve Functional Test Yes

6 Building 42 ITV wet system Ball valve Inspectors Test Valve 287006233 Andy Rolen 08/16/2024 Passed

Inspectors Test Valve Functional Test Yes

NFPA 25, Edition 2011

N

FP

A

9ee2a713-2681-49ec-aa72-7093a816ae41 | NFPA 25 | 08/17/2024

INSPECTORS TEST VALVE

7 Building 4 ITV wet system

(room 4-9) Gate valve Inspectors Test Valve 287005557 Andy Rolen 08/16/2024 Passed

Inspectors Test Valve Functional Test Yes

HOSE VALVE OUTLET

# LOCATION DESCRIPTION MAKE DEVICE TYPE BARCODE INSPECTOR DATE OF TEST RESULT

1 Parking garage Level B East entry Hose valve Hose Valve Outlet 287006204 Andy Rolen 08/16/2024 Passed

Define Type Of Hose Valve Class 1 (2.5")

What Is The Size Of This Hose Valve? 2.5"

Quarterly - Hose Valve Questions

Hose caps are in place and not damaged. Yes

Hose threads are not damaged. Yes

Valve handles are present and not damaged. Yes

Gaskets are not damaged or showing signs of deterioration. Yes

No leaks are present. Yes

Valves are not obstructed or otherwise not capable of normal operation. Yes

Annual - Hose Valve Questions

Hose Valve Exercised? Yes

2 Parking garage Level B north elevator stairwell Hose valve Hose Valve Outlet 287006203 Andy Rolen 08/16/2024 Passed

Define Type Of Hose Valve Class 1 (2.5")

What Is The Size Of This Hose Valve? 2.5"

Quarterly - Hose Valve Questions

Hose caps are in place and not damaged. Yes

Hose threads are not damaged. Yes

Valve handles are present and not damaged. Yes

Gaskets are not damaged or showing signs of deterioration. Yes

No leaks are present. Yes

Valves are not obstructed or otherwise not capable of normal operation. Yes

Annual - Hose Valve Questions

Hose Valve Exercised? Yes

3 Parking garage Middle of garage level SB Hose connection Hose Valve Outlet 287005595 Andy Rolen 08/16/2024 Passed

Define Type Of Hose Valve Class 1 (2.5")

What Is The Size Of This Hose Valve? 2.5"

Quarterly - Hose Valve Questions

Hose caps are in place and not damaged. Yes

Hose threads are not damaged. Yes

Valve handles are present and not damaged. Yes

Gaskets are not damaged or showing signs of deterioration. Yes

No leaks are present. Yes

Valves are not obstructed or otherwise not capable of normal operation. Yes

Annual - Hose Valve Questions

Hose Valve Exercised? Yes

NFPA 25, Edition 2011

N

FP

A

9ee2a713-2681-49ec-aa72-7093a816ae41 | NFPA 25 | 08/17/2024

HOSE VALVE OUTLET

4 Parking garage North stairs level

SB

Hose connection Hose Valve Outlet 287005597 Andy Rolen 08/16/2024 Passed

Define Type Of Hose Valve Class 1 (2.5")

What Is The Size Of This Hose Valve? 2.5"

Quarterly - Hose Valve Questions

Hose caps are in place and not damaged. Yes

Hose threads are not damaged. Yes

Valve handles are present and not damaged. Yes

Gaskets are not damaged or showing signs of deterioration. Yes

No leaks are present. Yes

Valves are not obstructed or otherwise not capable of normal operation. Yes

Annual - Hose Valve Questions

Hose Valve Exercised? Yes

5 Parking garage West stairs level B Hose connection Hose Valve Outlet 287005593 Andy Rolen 08/16/2024 Passed

Define Type Of Hose Valve Class 1 (2.5")

What Is The Size Of This Hose Valve? 2.5"

Quarterly - Hose Valve Questions

Hose caps are in place and not damaged. Yes

Hose threads are not damaged. Yes

Valve handles are present and not damaged. Yes

Gaskets are not damaged or showing signs of deterioration. Yes

No leaks are present. Yes

Valves are not obstructed or otherwise not capable of normal operation. Yes

Annual - Hose Valve Questions

Hose Valve Exercised? Yes

6 Parking garage West stairs level

SB

Hose connection Hose Valve Outlet 287005599 Andy Rolen 08/16/2024 Passed

Define Type Of Hose Valve Class 1 (2.5")

What Is The Size Of This Hose Valve? 2.5"

Quarterly - Hose Valve Questions

Hose caps are in place and not damaged. Yes

Hose threads are not damaged. Yes

Valve handles are present and not damaged. Yes

Gaskets are not damaged or showing signs of deterioration. Yes

No leaks are present. Yes

Valves are not obstructed or otherwise not capable of normal operation. Yes

Annual - Hose Valve Questions

Hose Valve Exercised? Yes

NFPA 25, Edition 2011

N

FP

A

9ee2a713-2681-49ec-aa72-7093a816ae41 | NFPA 25 | 08/17/2024

HOSE VALVE OUTLET

7 Parking garage West stairs top floor Hose connection Hose Valve Outlet 287005592 Andy Rolen 08/16/2024 Passed

Define Type Of Hose Valve Class 1 (2.5")

What Is The Size Of This Hose Valve? 2.5"

Quarterly - Hose Valve Questions

Hose caps are in place and not damaged. Yes

Hose threads are not damaged. Yes

Valve handles are present and not damaged. Yes

Gaskets are not damaged or showing signs of deterioration. Yes

No leaks are present. Yes

Valves are not obstructed or otherwise not capable of normal operation. Yes

Annual - Hose Valve Questions

Hose Valve Exercised? Yes

LOW POINT DRAIN

# LOCATION DESCRIPTION MAKE DEVICE TYPE BARCODE INSPECTOR DATE OF TEST RESULT

1 Parking garage North stairs level

SB

Low point drain Low Point Drain 287005596 Andy Rolen 08/16/2024 Passed

Monthly Low Point Drain Questions

Has this been drained? Yes

2 Parking garage West stairs level

SB

Low point drain Low Point Drain 287005598 Andy Rolen 08/16/2024 Passed

Monthly Low Point Drain Questions

Has this been drained? Yes

NFPA 25, Edition 2011

N

FP

A

9ee2a713-2681-49ec-aa72-7093a816ae41 | NFPA 25 | 08/17/2024

EASY RISER OR SHOTGUN SYSTEM

# LOCATION DESCRIPTION DEVICE TYPE BARCODE INSPECTOR DATE OF TEST RESULT

1 Building 57 Wet system Easy Riser or Shotgun

System 287006205 Andy Rolen 08/16/2024 Passed

Make and Model Site built

What Size is This Easy Riser valve? 2.5”

Hydraulic Name Plate Present Yes

Record The Coverage Area Defined On The Hydraulic Plate 1000

Record The GPM On The Hydraulic Plate 377.49

Record The PSI On The Hydraulic Plate 100.67

Easy Riser or Shotgun Systems Weekly - Monthly - Questions

Inspect Check Valve For Exterior Damage Yes

Drains Leak Tight Yes

Trim Piping Leak Tight Yes

Trim Valves In Normal Position Yes

Gauges Reading Normal PSI Yes

Record The Pressure (PSI) Shown On The System Side Pressure Gauge. 150

Date the internal pipe inspection was performed? 02/11/2021

Date of Check Valves Internal Inspection 02/11/2021

Date of Gauges Replacement 02/11/2021

Date of Internal Inspection of Easy Riser or Shotgun Valve Strainers, Filters, And Restriction Orifices. 02/11/2021

Easy Riser or Shotgun Systems 5 Year Questions

All Gauges over 5 Years Replaced Yes

2 Building 6 Wet system Easy Riser or Shotgun

System 287006215 Ethan Williamson 08/16/2024 Passed

Make and Model Reliable Model C

What Size is This Easy Riser valve? 3”

Easy Riser or Shotgun Systems Weekly - Monthly - Questions

Inspect Check Valve For Exterior Damage Yes

Drains Leak Tight Yes

Trim Piping Leak Tight Yes

Trim Valves In Normal Position Yes

Gauges Reading Normal PSI Yes

Record The Pressure (PSI) Shown On The System Side Pressure Gauge. 175

Date the internal pipe inspection was performed? 02/11/2021

Date of Check Valves Internal Inspection 02/11/2021

Date of Gauges Replacement 02/11/2021

Date of Internal Inspection of Easy Riser or Shotgun Valve Strainers, Filters, And Restriction Orifices. 02/11/2021

Easy Riser or Shotgun Systems Quarterly - Semi Annual - Annual - Questions

Did Water Flow Alarm Devices, And Retards Test Satisfactorily? Yes

Inspector Test Opened & Free Of Obstruction / Discoloration Yes

NFPA 25, Edition 2011

N

FP

A

9ee2a713-2681-49ec-aa72-7093a816ae41 | NFPA 25 | 08/17/2024

3 Building 16 Wet system Easy Riser or Shotgun

System 287006223 Andy Rolen 08/16/2024 Passed

Make and Model Tyco CV-1F

What Size is This Easy Riser valve? 2.5”

Easy Riser or Shotgun Systems Weekly - Monthly - Questions

Inspect Check Valve For Exterior Damage Yes

Drains Leak Tight Yes

Trim Piping Leak Tight Yes

Trim Valves In Normal Position Yes

Gauges Reading Normal PSI Yes

Record The Pressure (PSI) Shown On The Water Supply Pressure Gauge. 175

Record The Pressure (PSI) Shown On The System Side Pressure Gauge. 175

Date the internal pipe inspection was performed? 02/10/2021

Date of Check Valves Internal Inspection 02/10/2021

Date of Gauges Replacement 02/10/2021

Date of Internal Inspection of Easy Riser or Shotgun Valve Strainers, Filters, And Restriction Orifices. 02/10/2021

Easy Riser or Shotgun Systems Quarterly - Semi Annual - Annual - Questions

Did Water Flow Alarm Devices, And Retards Test Satisfactorily? Yes

Inspector Test Opened & Free Of Obstruction / Discoloration Yes

Easy Riser or Shotgun Systems 5 Year Questions

All Gauges over 5 Years Replaced Yes

4 Building 42 Wet system Easy Riser or Shotgun

System 287006228 Andy Rolen 08/16/2024 Passed

Make and Model Tyco CV-1F

What Size is This Easy Riser valve? 2”

Easy Riser or Shotgun Systems Weekly - Monthly - Questions

Inspect Check Valve For Exterior Damage Yes

Drains Leak Tight Yes

Trim Piping Leak Tight Yes

Trim Valves In Normal Position Yes

Gauges Reading Normal PSI Yes

Record The Pressure (PSI) Shown On The Water Supply Pressure Gauge. 175

Record The Pressure (PSI) Shown On The System Side Pressure Gauge. 175

Retard Chamber Leak Tight And In Good Condition Yes

Date the internal pipe inspection was performed? 03/12/2021

Date of Check Valves Internal Inspection 03/12/2021

Date of Gauges Replacement 03/12/2021

Date of Internal Inspection of Easy Riser or Shotgun Valve Strainers, Filters, And Restriction Orifices. 03/12/2021

Easy Riser or Shotgun Systems 5 Year Questions

All Gauges over 5 Years Replaced Yes

NFPA 25, Edition 2011

N

FP

A

9ee2a713-2681-49ec-aa72-7093a816ae41 | NFPA 25 | 08/17/2024

5 Building 4 Wet system (room

4-17) Easy Riser or Shotgun

System 287005556 Andy Rolen 08/16/2024 Passed

Make and Model 2000 site built

What Size is This Easy Riser valve? 2.5”

Easy Riser or Shotgun Systems Weekly - Monthly - Questions

Inspect Check Valve For Exterior Damage Yes

Drains Leak Tight Yes

Trim Piping Leak Tight Yes

Trim Valves In Normal Position Yes

Gauges Reading Normal PSI Yes

Record The Pressure (PSI) Shown On The System Side Pressure Gauge. 167

Date the internal pipe inspection was performed? 03/08/2021

Date of Check Valves Internal Inspection 03/08/2021

Date of Gauges Replacement 03/08/2021

Date of Internal Inspection of Easy Riser or Shotgun Valve Strainers, Filters, And Restriction Orifices. 03/08/2021

Easy Riser or Shotgun Systems Quarterly - Semi Annual - Annual - Questions

Did Water Flow Alarm Devices, And Retards Test Satisfactorily? Yes

Inspector Test Opened & Free Of Obstruction / Discoloration Yes

Easy Riser or Shotgun Systems 5 Year Questions

All Gauges over 5 Years Replaced Yes

6 Building 3 Wet system (Room

09-2) Easy Riser or Shotgun

System 287005074 Andy Rolen 08/16/2024 Passed

Make and Model Site built. Stick system

What Size is This Easy Riser valve? 2.5

Easy Riser or Shotgun Systems Weekly - Monthly - Questions

Inspect Check Valve For Exterior Damage Yes

Drains Leak Tight Yes

Trim Piping Leak Tight Yes

Trim Valves In Normal Position Yes

Gauges Reading Normal PSI Yes

Record The Pressure (PSI) Shown On The System Side Pressure Gauge. 165

Date the internal pipe inspection was performed? 03/12/2021

Date of Check Valves Internal Inspection 03/12/2021

Date of Gauges Replacement 03/12/2021

Date of Internal Inspection of Easy Riser or Shotgun Valve Strainers, Filters, And Restriction Orifices. 03/12/2021

Easy Riser or Shotgun Systems Quarterly - Semi Annual - Annual - Questions

Did Water Flow Alarm Devices, And Retards Test Satisfactorily? Yes

Inspector Test Opened & Free Of Obstruction / Discoloration Yes

Easy Riser or Shotgun Systems 5 Year Questions

All Gauges over 5 Years Replaced Yes

NFPA 25, Edition 2011

N

FP

A

9ee2a713-2681-49ec-aa72-7093a816ae41 | NFPA 25 | 08/17/2024

WET SYSTEM

1 Building 2 Wet system Wet alarm valve Wet System 287005546 Andy Rolen 08/16/2024 Passed

Wet Systems - Weekly - Monthly Questions

Make and Model Firematic 4-AV

What Size Is This Wet Pipe Valve 4

Inspect Alarm Valve For Exterior Damage Yes

Drai…