B08_Attachment_4__-_Backflow_Prevention_Device_Test_Form.pdf
PDF 367 KB Posted
- Attached to
- Fire Protection Sys Inspect/Test - 12 AK Parks Federal contract opportunity
- Solicitation number
- 140P9725Q0013
About this file
This document is a National Park Service (NPS) / AKRO Backflow Prevention Device Inspection and Test Report form for documenting detailed technical assessments of backflow preventer devices. The two-page form is designed to comprehensively record specific details about a backflow prevention device, including location, device type, manufacturer, orientation, and critical performance testing parameters such as pressure drops, valve performance, and forward flow tests.
The form requires extensive technical documentation, including checks on reduced pressure principal assemblies and double check valve assemblies, with specific sections for initial measurements, repairs made, and final test results. A critical component is the forward flow test section, which mandates testing for fire sprinkler systems downstream of the backflow preventer, with options for flow rate measurement and potential alternative testing methods if standard procedures cannot be performed. The document is part of a solicitation (140P9625Q0013) for Fire Protection Systems Inspection & Testing across 12 National Parks in Alaska, indicating its use in maintaining critical infrastructure safety systems for the Department of the Interior National Park Service Alaska Region.
View the file
Other files for this federal contract opportunity
Show all 20
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Backflow Preventer Device Page 1 of 2 Revised 5/14/2019
National Park Service / AKRO Inspection and Test Report (complete a separate form for each system)
BACKFLOW PREVENTION DEVICE
Park Alpha Code:___________ FMSS Location No.: _______ FMSS Asset No: _________
Location Description: _________________________________________________________
Date of Test: _________________________________ Time: _____________________
Location: Inside Outside Above Ground Pit
Usage: Fire Domestic Irrigation
Type of Device: RP DC DCDA RPDA
Manufacturer: ___________________________ Model No.: ______________________________
Size: ___________________________________ Serial No.: _______________________________
Orientation: Vert Up Vert Down Horizontal Height off Floor: ___________( in/ft)
REDUCED PRESSURE PRINCIPAL ASSEMBLE
*Relief ports on RPZ free of continuous discharge? Yes No
Date Installed:
DOUBLE CHECK VALVE ASSEMBLY
Apparent Pressure Drop
Across First Check
Valve________
Date Rebuilt:
Check Valve #1 Check Valve #2 Relief Valve PVB / SVB
Held at _______PSID
Leaked
Held at _______PSID
Closed Tight
Leaked
Opened at _______PSID
Did not open
AIR INLET
Opened at _______PSID
Did not open
Cleaned
Replaced
Cleaned
Replaced
Cleaned
Replaced
Cleaned
Replaced
________ PSID
Closed Tight
________ PSID Air Inlet _______PSID
Check Valve _______PSID
Leaked
________ PSID
F
IN
A L
R
E P
A
IR
S M
A D
E
IN
IT
IA
L
PASS FAIL No. 2 Shutoff Valve
Closed Tight
Supply Pressure ___________
Backflow Preventer Device Page 2 of 2 Revised 5/14/2019
Test Kit Manufacturer: __________________ Model: ______________________________
Serial No.: _______________________________ Last Calibration Date: _________________
Certified Tester: _________________________ Certified Tester No.: __________________
Signature: ______________________________________________________________________
FORWARD FLOW TEST—Required by NPS for all backflow preventers where fire sprinkler systems are located downstream of the backflow preventer. The test shall include forward flow test of the system at the designed flow rate, including hose stream demand. For back-flow preventers sized 2 inches and less, forward flow test shall be acceptable to conduct without measuring flow, where the test outlet is a size to flow the system demand.
Forward Flow Test Performed: Yes No
Main Drain Test Performed: Yes No
Design Flow Rate: __________________ GPM Actual Flow Rate: ______________ GPM
If Flow Rate based on Main Drain Test, use Estimated in place of Actual.
For cases where neither Forward Flow nor Main Drain could be performed, or Main Drain flow does not meet intent of System Design, note this as a Deficiency below.
For these cases, note which of the options listed below may be applicable:
1) Reverse FDC check valve and flow out the FDC check valve
2) Dismantle riser and install temporary test header
3) Modification of riser for installation of permanent test header
Location: _____________________________________________________________________
Deficiency: ___________________________________________________________________
Recommended Resolution: _____________________________________________________
DEFICIENCIES FOUND? Yes No List items that were not corrected. Use this section or attach itemized sheet.
REPAIRS: All deficiencies have been corrected: N/A Yes No
DEFICIENCIES
File details come from the government source that posted it. Updated .