NPS_Forms_Required_for_Fire_Mains Hydrants_(1).pdf

Contractor’s Material and Test Certificate for Aboveground Piping (Form AS-5)

PROCDURE

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)

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:

Backflow Prevention Assembly Test And Maintenance Record (Form BF-1)

I. GENERAL INFORMATION

Address: FMSS Asset ID Number:

Location of Assembly:

Date of Installation: Incoming Line Pressure:

Manufacturer: Model No.

Serial No.: Size:

Assembly Type: RP RP Detector DC Detector PVB

II. TESTS AND REPAIRS INFORMATION

Differential Pressure Check Valve No. 1 Check Valve No. 2 Relief Valve

Initial Test: Leaked Leaked Opened at psid

Closed Tight Closed Tight Did not Open

Pressure drop across the Pressure drop across the first check valve is second check valve psid psid

Repairs: List Repairs and List Repairs and List Repairs and Corrections Corrections Corrections

Final Test Closed Tight Closed Tight Opened at psid

Condition of No. 1 Control Valve: Closed Tight Leaked

Condition of No. 2 Control Valve: Closed Tight Leaked

Remarks: Assembly Failed Assembly Passed

III. APPROVALS

Name of Technician Company Name:

Address:

Phone No.: Certificate Number: Gauge Number:

Signature of Technician:

Date:

Regional Structural Fire Management Officer (or his designee):

(p. 1 of 3)

CONTRACTOR’S MATERIAL AND TEST CERTIFICATE FOR ABOVEGROUND PIPING

1 Measured from time inspector’s test connection is opened 2 NFPA 13 only requires the 60-second limitation in specific sections

PROCEDURE

Upon completion of work, inspection and tests shall be made by the contractor’s representative and witnessed by an owner’s representative.

All defects shall be corrected and system left in service before contractor’s personnel finally leave the job.

A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and contractor.

It is understood the owner’s representative’s signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to comply with approving authority’s requirements or local ordinances.

Property address

Date

Accepted by approving authorities (names)

Address

Installation conforms to accepted plans.

Equipment used is approved.

If no, explain deviations.

Has person in charge of fire equipment been instructed as to location of control valves and care and maintenance of this new equipment? If no, explain

Have copies of the following been left on the premises?

1. System components instructions

2. Care and maintenance instructions

3. NFPA 25

Location of System Supplies buildings

Make Model Year of

Manufacture Orifice

Size Quantity Temperature rating

Sprinklers

Pipe and Fittings

Alarm Valve or

Flow Indicator

Maximum Time to Operate Through Test Connection

Make ModelType Minutes Seconds

Dry Pipe Operating

Test

Q. O. D.

Make Serial no. Make Model Serial no.

Time to Trip Through Test Connection1,2

Water Pressure

Air Pressure

Trip Point Air Pressure

Time Water Reached

Test Outlet1,2 Alarm

Operated Properly

Minutes Seconds psi psi psi Minutes Seconds Yes No

Without Q.O.D.

With

Q.O.D.

If no, explain

Type of pipe Type of fittings

Alarm Device

Model

Dry Valve

Property name

Instructions

Plans

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

© 2002 National Fire Protection Association

(p. 2 of 3)

Deluge and Preaction

Valves

Operation Pneumatic Electric Hydraulics

Piping supervised Yes No Detecting media supervised Yes No

Does valve operate from the manual trip, remote, or both control stations?

RemoteManual Both

Is there an accessible facility in each circuit for testing?

If no, explain.

Yes No

Make Model Does each circuit operate supervision loss alarm?

Does each circuit operate valve release?

Maximum time to operate release

Yes No Yes No Minutes Seconds

Test Description

Hydrostatic: Hydrostatic tests shall be made at not less than 200 psi (13.6 bar) for 2 hours or 50 psi (3.4 bar) above static pressure in excess of 150 psi (10.2 bar) for 2 hours. Differential dry-pipe valve clappers shall be left open during the 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 1Z\x 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 1Z\x psi (0.1 bar) in 24 hours.

Tests

All piping hydrostatically tested at Dry piping pneumatically tested Equipment operates properly psi ( bar) for hours If no, state reason.

Do you certify as the sprinkler contractor that additives and corrosive chemicals, sodium silicate or derivatives of sodium silicate, brine, or other corrosive chemicals were not used for testing systems or stopping leaks?

Drain test

Reading of gauge located near water supply test connection

Yes No psi ( bar) Residual pressure with valve in test connection open wide

Underground mains and lead-in connections to system risers flushed before connection made to sprinkler piping Verified by copy of the Contractor’s Material and Test Certificate for Underground Piping Flushed by installer of underground sprinkler piping

Yes No

Yes No

Other Explain

Blank Testing Gaskets

Number used Locations Number removed

Welding

Do you certify as the sprinkler contractor that welding procedures comply with the requirements of at least AWS B2.1?

Do you certify that the welding was performed by welders qualified in compliance with the requirements of at least AWS B2.1?

Do you certify that the welding was carried out in compliance with a documented quality control procedure to ensure 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?

Welding piping Yes No

If yes . . .

Yes No

Yes No

Yes No

Cutouts (Discs)

Do you certify that you have a control feature to ensure that all cutouts (discs) are retrieved?

Yes No

Pressure Reducing Valve Test

Make and model Setting

Location and floor Static pressure

Residual pressure (flowing) Flow rate

Inlet (psi) Outlet (psi) Inlet (psi) Outlet (psi)

If powder-driven fasteners are used in concrete, has representative sample testing been satisfactorily completed?

If no, explainYes No

Flow (gpm) psi ( bar)

Yes No Yes No

(p. 3 of 3)

Nameplate provided Hydraulic Data

Nameplate Yes No

If no, explain.

Remarks Date left in service with all control valves open

Signatures

Name of sprinkler contractor

Tests witnessed by

For property owner (signed) Title Date

For sprinkler contractor (signed) Title Date

Additional explanations and notes

Fire Hydrant Inspection and Flow Testing Form

(Form FH-1)

Information in this form covers the minimum requirements of NFPA 291-2002 for fire hydrant flow testing. Separate forms are available to inspect, test and maintain fire pumps, water tanks and other fire protection systems. More frequent inspection, testing and maintenance may be necessary depending on the conditions of the water supply.

Date of Test: (All data refers to the flow performed on this date) Time of Test:

Park:

Location of Fire Hydrant:

Fire Hydrant Number: Type of Hydrant: Wet Barrel Dry Barrel

Purpose of Flow Test (check one): Periodic Maintenance New Hydrant Repair of Hydrant Upgrade to Water System

Special Request (describe):

Test Performed by:

Test Witnessed by:

Notes: 1) All questions are to be answered Yes, No. All No answers are to be explained in Part III of this form.

2) Inspection, Testing and Maintenance are to be performed with water supplies (including fire pumps) in service, unless the impairment procedures of Chapter 11 of NFPA 25 and the appropriate NPS Job Plan are followed.

Part I – Inspection A. Is hydrant accessible and free of obstructions and physical damage? Yes No

B. Is lowest hydrant port at least 18 inches above the ground? Yes No

C. Do all hydrant ports have caps? Yes No

D. Do all hydrant caps have gaskets, and are gaskets in good condition? Yes No

E. Is hydrant color coded and is coding in accordance with NFPA 291? Yes No

F. Are hydrant markers (street markers and/or snow sticks) in place? Yes No

G. Are hydrant street valves visible and accessible? Yes No

H. Is hydrant valve stem in good condition? Yes No

I. Is the ground around the hydrant dry and stable? Yes No

NPS Representative (print name) Signature and Date

Part II – Test

Consumption rate during test

If pumps affect test, indicate pumps operating

If reduce pressure valves affect test, indicate valves operating

Flow Hydrant: A1 A2 A3 A4

Size Nozzle:

Pitot Reading:

Discharge Coefficient: Total GPM

GPM:

Static A psi Residual B psi

Projected Results @ 20 psi Residual gpm; or @ psi Residual gpm

Remarks:

Location map: A location map should be included on the backside of this form. Show line sizes and distances to next cross connected line.

Show valves and hydrant branch lines. Indicate North. Show flowing hydrants – A1, A2, A3, A4. Show location of static and residual – Label B.

Indicate B Hydrant Sprinkler Other (identify)

100 200 300 400 500 600 700 800 900 1000

Contractor’s Material and Test Certificate for Underground Piping (Form AS-4)

PROCDURE

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.

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):