Attachment_7_Aboveground_Piping_Acceptance_Test_Form_(Form_AS-5).docx
DOCX document 69 KB Posted
- Attached to
- OLYMPIC MAYFIELD HOUSE FIRE SPRINKLER SYSTEM Federal contract opportunity
- Solicitation number
- 140P8326Q0007
About this file
This is a Contractor's Material and Test Certificate form (Form AS-5) for aboveground fire sprinkler piping systems, designed to document inspection, testing, and acceptance procedures upon project completion. The form serves as the official record that contractors and Contracting Officers must jointly complete and sign before the contractor's personnel leave the job site, with copies distributed to the authority having jurisdiction, park unit, and contractors.
The form requires comprehensive documentation across multiple categories: verification that installation conforms to accepted plans and approved equipment is used; confirmation that fire equipment personnel have been instructed on control valve locations and maintenance; specification of sprinkler system details including riser location, FMSS asset ID, sprinkler make/model, and orifice size; testing results for alarm valves, dry pipe systems, backflow prevention devices, and deluge/pre-action valves; and detailed hydraulic testing data. Testing requirements include hydrostatic pressure tests at minimum 200 psi for two hours and pneumatic tests with allowable air pressure drops not exceeding 1.5 psi in 24 hours. The form additionally addresses welding compliance with AWS D10.9 standards, retrieval of cutouts and testing gaskets, underground main flushing verification, and nameplate documentation. All sections require certification signatures from both the sprinkler contractor and the Contracting Officer or designee, with explicit notation that such signatures do not prejudice claims against the contractor for defective materials, poor workmanship, or non-compliance with applicable regulations or local ordinances.
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Text version
Contractor’s Material and Test Certificate for Aboveground Piping (Form AS-5)
PROCEDURE
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. 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 contactor’s representative and the Contracting Officer or his/her designee. Copies shall be prepared for the authority having jurisdiction, the park unit, and contractors. It is understood that the signature of the Contracting Officer or his/her designee in no way prejudices any claim against the contractor for faulty material, poor workmanship, or failure to comply with the requirements of the authority having jurisdiction or local ordinances.
PLANS
Accepted by [Contracting Officer or his/her designee]:
| (print) | (signature) | |
| Park/Office: | Phone No.: | |
| 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 SYSTEM RISER
Riser location: Piping Supplies building(s): FMSS Asset ID Number:
SPRINKLERS
| Year of | Orifice | Temperature | |||
| Make | Model | Manufacturer | Size | Quantity | Rating |
PIPE FITTINGS
Pipe conforms to standard (If no, explain)
Fittings conform to standard (If no, explain)
Solicitation (RFQ) no. 140P8326Q0007 – Attachment 7
ALARM VALVE OR FLOW INDICATOR
Maximum Time to Alarm Device Operate Through Test Pipe
| Type |
| Make |
| Model |
| Minutes |
| Seconds |
DRY PIPE OPERATING TEST
Dry Valve Quick Opening Device (Q.O.D)
| Make |
| Model |
| Serial No. |
| Make |
| Model |
| Serial No. |
Time to Trip
| Trip Point |
| Time Water |
| Alarm |
| Through |
| Water |
| Air |
| Air |
| Reached |
| Operated |
| Test Pipe* |
| Pressure |
| Pressure |
| Pressure |
| Test Outlet* |
| Properly |
| Min. |
| Sec. |
| Psi (Bar) |
| Psi (Bar) |
| Psi (Bar |
| Min. |
| Sec. |
| Yes |
| No |
Without Q.O.D
With Q.O.D comments:
BACKFLOW PREVENTION DEVICE (Forward Flow Test)
Method of Flow: Main Drain Fire Department Connection Fire Department Connection By-pass
* Test shall deliver designed flow rate for system, including hose stream, where hydrants or inside hose stations are located downstream of the backflow preventer.
DELUGE AND PRE-ACTION VALVES
| Operation: | Pneumatic |
| Electric |
Hydraulic
| Piping supervised: | Yes |
| No |
| Detecting media supervised: |
| Yes |
| No |
Is there an accessible facility in each circuit for testing: Yes No If no, explain.
Make
Model
| Does each circuit operate supervision loss alarm? |
| Does each circuit operate valve release? |
| Maximum Time to operate release |
| Yes |
| No |
| Yes |
| No |
| Min. |
| Sec. |
TEST (description) 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. Differential dry pipe valve clappers shall be left open during test to prevent damage. All aboveground piping leakage shall be stopped.
PNEUMATIC: Establish 40 psi (2.7 bar) air pressure and measure drop, which shall not exceed 11/2 psi (0.1 bar) in 24 hours. Test pressure tanks at normal water level and air pressure and measure air pressure drop, which shall not exceed 11/2 psi (0.1 bar) in 24 hours.
*Measure from time inspector’s test pipe is opened
TEST
| All piping hydrostatically tested at | psi (bar) for | hrs. Dry piping pneumatically tested: | Yes | No | ||
| Equipment operates properly: | Yes | No | ||||
| If no, state reason. | Drain test—Reading of gauge located near water supply test pipe: Static pressure: | psi (bar) | ||||
| Drain test—Residual pressure with valve in test pipe open wide: | psi (bar) | |||||
| Underground mains and lead-in connections to system risers flushed before connections made to sprinkler piping (verified by review of completed copy of NPS Form AS-4?) | Yes | No | Other | |||
| Flushed by installer of underground sprinkler piping: | Yes | No | Other |
If other, explain.
BLANK TESTING GASKETS
Number used Locations Number removed
CUTOUTS (discs) Do you certify that you have a control feature to ensure that all cutouts (discs) are retrieved? Yes No
Welding
| Welded piping: | Yes | No |
| If yes, | Yes | No |
Do you certify as the sprinkler contractor that welding procedures comply with the requirements of at least AWS D10.9, Level AR-3?
Do you certify that the welding was performed by welders qualified in compliance with the requirements of at least AWS D10.9, Level AR-3?
Do you certify that welding was carried out in compliance with a documented quality control procedure to insure that all discs are retrieved, that openings in piping are smooth, that slag and other welding residue are removed, and that the internal diameters of piping are not penetrated?
HYDRAULIC DATA NAMEPLATE
Nameplate provided? Yes No If no, explain. Date system 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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