B08_Attachment_8_-_Fire_Pump_Test_Form.pdf

Fire Pump System Page 1 of 3 Revised 12/16/15

National Park Service / AKRO

Inspection and Test Report (complete a separate form for each system)

FIRE PUMP SYSTEM – RESIDENTIAL PUMP COMMERCIAL PUMP

Park Alpha Code: ________

Location Description: ______________________

Date of Test:_________________________

Time:_________________

Pump Make: ______________________ Pump Model / SN: _____________________________

Controller Make ______________________ Controller Model / SN _____________________________

DEFICIENCIES FOUND? Yes No List items that were not corrected. Use the Deficiencies section or attach itemized sheet

REPAIRS: All deficiencies have been corrected N/A Yes No

This certifies that the fire and life safety system has been inspected and tested for functional operation in accordance with applicable NFPA 20 and NFPA 25 standards, and has been properly tagged and/or labeled. Any discrepancies found are noted in this report with code references for corrective action by the Owner/Responsible Person.

Technician Name (printed): ______________________ Company: ______________________________

Signature: ___________________________________ Phone #: _______________________________

State Certification No.: _________________________

National/NICET No.: ___________________________

WATER STORAGE TANK

1. Water level is within normal range Yes No

2. Heating system is functional N/A Yes No

3. Exterior inspection of tank structure, supports, vents, and outlets, shows no evidence of accelerated corrosion or damage.

Yes No

4. Interior inspection was performed and shows no evidence accelerated corrosion, pitting, debris, or biological growth. (required at 5 year intervals)

N/A Yes No

5. Supply valve to fire pump is open Yes No

6. Automatic fill piping valves are open and operational N/A Yes No

ELECTRIC DRIVEN PUMP

7. The pump was started automatically by inducing a drop in pressure Yes No

8. Pressure readings during a no-flow (churn) condition.

Suction PSI: ______ Discharge PSI: _______

Yes No

9. Adjust pump packing glands as necessary for slight discharge Yes No

10. The pump casing relief valve operates properly Yes No

11. Check packing boxes, bearing, or pump casing for overheating Yes No

12. The electric pump ran properly for a minimum 10 minutes. Yes No

Karma Torres Text Box Asset No.:

Karma Torres Line

Karma Torres Snapshot

Karma Torres Line

Karma Torres Line

Fire Pump System Page 2 of 3 Revised 12/16/15

DIESEL DRIVEN PUMP

13. The pump was started automatically by inducing a drop in pressure Yes No

14. Pressure readings during a no-flow (churn) condition.

Suction PSI: ______ Discharge PSI: _______

Yes No

15. Adjust pump packing glands as necessary for slight discharge Yes No

16. The pump casing relief valve operates properly Yes No

17. Check packing boxes, bearing, or pump casing for overheating Yes No

18. Fuel level is at least 2/3 full. Yes No

19. Oil level is within acceptable range. Yes No

20. Batteries voltage reading are within acceptable range Yes No

21. The fuel filter/strainer has been serviced. Yes No

22. The diesel pump ran properly for a minimum 30 minutes. Yes No

PUMP CONTROLLERS

23. A pump controller regulates a commercial fire pump and is UL listed and operates per NFPA 20

N/A Yes No

24. A pump controller regulates a jockey pump and operates as required by

NFPA 20

N/A Yes No

25. A pump controller regulates a residential-type pump and operates as required by NFPA 20

N/A Yes No

FLOW TEST - RATED CAPACITY (GPM) ________ RATED SPEED (RPM) ________ RATED PRESSURE (PSI) _________

26. An annual flow test was performed per NFPA 20 at minimum, rated, and peak flows through approved test devices

N/A Yes No

27. The pump runs smoothly without unusual noise or vibration throughout the test. Yes No

28. The gauges passed a 5-year pressure gauge comparison test with a calibrated gauge.

Date for next test:______________

Yes No

29. Defective gauges have been replaced or recalibrated. N/A Yes No

30. The pump performs at its rated capacity and at 150% of its rated capacity (or the maximum capacity the water supply will accommodate)

Yes No

31. Flow readings measured:

Churn (no flow): ______ gpm Rated Capacity: _____ gpm 150% Rated Capacity: _____ gpm

32. Pressure readings - Discharge Gauge Churn (no flow): _______ psi Rated Capacity: _____ psi 150% Rated Capacity: _____ psi

33. Pressure readings – Suction Gauge:

Churn (no flow): _______ psi Rated Capacity: _____ psi 150% Rated Capacity: _____ psi

34. Flow Test device used: Hoses and Pitot Tube FM flowmeter Diffuser/Hosemonster

TRANSFER SWITCH

35. A simulated power failure during peak flow automatically activated the transfer switch within 10 seconds.

N/A Yes No

36. After the automatic connection was made to an alternate power source;

peak flow was redelivered within 30 seconds.

N/A Yes No

37. The manual emergency transfer equipment operated properly during peak flow and peak flow was redelivered within 30 seconds.

N/A Yes No

SYSTEM MONITORING

38. The pump controller panel sends the proper signals to the building

FACP.

N/A Yes No

39. The suppression control panel operates on standby power N/A Yes No

40. Signals were received at the monitoring company. N/A Yes No

Fire Pump System Page 3 of 3 Revised 12/16/15

Deficiencies

Resolved

Location:

Deficiency:

Recommended Resolution:

NFPA 20 or NFPA 25 reference: