Attachment_6_Underground_Piping_Acceptance_Test_Form_(Form_AS-4).docx
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- Attached to
- OLYMPIC MAYFIELD HOUSE FIRE SPRINKLER SYSTEM Federal contract opportunity
- Solicitation number
- 140P8326Q0007
About this file
This is an Underground Piping Acceptance Test Form (Form AS-4) used to document the inspection, testing, and acceptance of underground fire sprinkler piping systems upon completion of installation work. The form is a contractor's material and test certificate that must be completed and signed by both a contractor's representative and the Contracting Officer or designee before the system is left in service. The form applies to the Olympic Mayfield House Fire Sprinkler System installation project (Solicitation 140P8326Q0007) for the Department of the Interior National Park Service Pacific West Region.
The form requires documentation of three primary testing procedures: flushing tests (flow rates ranging from 400 to 2,000 gallons per minute depending on pipe diameter, until water runs clear), hydrostatic tests (minimum 200 psi for two hours or 50 psi above static pressure for two hours), and leakage tests (maximum allowable leakage of 2 quarts per hour per 100 joints). The certificate also verifies that underground pipes and joints conform to standards, equipment is approved, fittings meet specifications, anchorage requirements are met, hydrants are installed and operational, control valves are properly positioned, and that fire equipment personnel have received instruction on equipment location and maintenance. All defects must be corrected prior to system acceptance, and copies of the completed certificate must be provided to the authority having jurisdiction, owners, and contractors.
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Text version
Contractor’s Material and Test Certificate for Underground Piping (Form AS-4)
PROCUDURE
Upon completion of work, inspection and tests shall be made by the contractor’s representative and witnessed by the Contracting Officer or his/her designee representative. All defects shall be corrected and the system left in service before contractor’s personnel finally leave the job.
A certificate shall be filled out and signed by both a Contractor’s representative and the Contracting Officer or his/her designee. Copies shall be prepared for the authority having jurisdiction, owners, and contractors. It is understood that the signature of the Contracting Officer or his/her designee in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to comply with approving requirements of the authority having jurisdiction or local ordinances.
PLANS
Accepted by [Contracting Officer or his/her designee]:
(print) (signature)
| Address: | Installation conforms to accepted plans? Yes | No | |
| Equipment used is approved? Yes | No |
If no, explain deviations.
INSTRUCTIONS
| Has person in charge of fire equipment been instructed as to location of control valves and care and maintenance of this new equipment? Yes | No | |||
| If no, explain. | Have copies of appropriate instructions and care and maintenance charts been left on premises? | Yes | No If no, explain. |
LOCATION OF WATER MAIN
Piping Supplies building(s): FMSS Asset ID Number:
| UNDERGROUND PIPES AND JOINTS clamped, strapped, or blocked in accordance with standard Pipe conforms to | standard | Yes | No | ||||
| (If no, explain) | Fittings conform to | standard | Yes | No | |||
| (If no, explain) | Joints needing anchorage clamped, strapped, or blocked in accordance with | standard? Yes | No (If no, explain) |
TEST DESCRIPTION
Flushing: Flow the required rate until water is clear as indicated by no collection of foreign material in burlap bags at outlets such as hydrants and blow-offs. Flush at flows not less than 400 gpm (1514 L/min) for 4-in. (102-mm) pipe, 600 gpm (2271 L/min) for 5-in. (127-mm) pipe, 750 gpm (2839 L/min) for 6-in. (152-mm) pipe, 1000 gpm (3785 L/min) for 8-in. (203-mm) pipe, 1500 gpm (5678 L/min) for 10-in. (254-mm) pipe and 2000 gpm (7570 L/min) for 12-in. (305-mm) pipe. When supply cannot produce stipulated flow rates, obtain maximum available.
Hydrostatic: Hydrostatic tests shall be made at not less than 200 psi (13.6 bar) for two hours or 50 psi (3.4 bar) above static pressure in excess of 150 psi (10.2 bar) for two hours.
Solicitation (RFQ) no. 140P8326Q0007 – Attachment 6
Leakage: New pipe laid with rubber gasketed joints shall, if the workmanship is satisfactory, have little or no leakage at the joints. The amount of leakage at the joints shall not exceed 2 qts per hr. (1.89 L/h) per 100 joints irrespective of pipe diameter. The leakage shall be distributed over all joints. If such leakage occurs at a few joints the installation shall be considered unsatisfactory and necessary repairs made. The amount of allowable leakage specified above may be increased by 1 fl oz per in. valve diameter per hour (30 mL/25 mm/h) for each metal-seated valve isolating the test section. If dry barrel hydrants are tested with the main valve open, so the hydrants are under pressure, an additional 5 oz per minute (150 mL/min) leakage is permitted for each hydrant.
TESTING DATA
Flushing Tests New underground piping flushed according to standard. Yes No By (company) If no, explain.
| How flushing flow was obtained: |
| Public water |
| Tank or reservoir |
| Fire pump |
| Through what type opening |
| Hydrant butt |
| Open pipe |
| Lead-ins flushed according to | standard | Yes | No | ||
| By (company) | If no, explain. | ||||
| How flushing flow was obtained | Public water | Tank or reservoir | Fire pump Through what type opening | Y connection to flange and spigot | Open pipe |
Hydrostatic Test All new underground piping hydrostatically tested at psi (bar) for hours Joints covered? Yes No Leakage Test Total amount of leakage measured: gals (L) hours Allowable leakage: gals (L) hours
HYDRANTS
Number installed: Type and make: All operate satisfactorily? Yes No
CONTROL VALVES
Water control valves left wide open? Yes No If no, state reason.
Hose threads of fire department connections and hydrants interchangeable with those of fire department answering alarm? Yes No Date left in service with all control valves open:
| Remarks: | SIGNATURES | |||||
| Sprinkler Contractor Business Name: | Address: | Phone No.: | License or Certificate Number: | Name of Technician: | Signature: |
Regional Structural Fire Management Officer (of his designee): Date:
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