TE-11-14_WATER STORAGE TANKS.pdf

This form covers the minimum requirements of NFPA 25-2011 for water storage tanks. Separate forms are available for inspection, testing, and maintenance of other portions of the fire protection system of which the water tank is a part. More frequent inspection, testing, and maintenance may be necessary depending on the conditions of the occupancy and the water supply.

Notes:

All questions are to be answered Yes, No, or Not Applicable. All "No" answers are to be explained in the Comments for this form.

1.

Inspection, Testing and Maintenance are to be performed with water supplies (including fire pumps) in service, unless the impairment procedures of Chapter 15 of NFPA 25 are followed.

2.

The work covered on this form is (select one):

Date of Work All responses refer to the current work (inspection, testing and maintenance) performed on this date.

Owner:

Owner's Phone Number:

Owner's Address:

Property Being Evaluated:

Property Address:

Tanks(s):

Part I - Owner's Section A. Is the water storage tank in service? Yes No B. Remained in service since the last inspection? Yes No

C. Systems supplied by the tank free of actuation of devices or alarms since the last inspection?

Yes No

Owner or Representative Signature Date Part II - Inspector's Section A. Inspections

1. Daily items during cold weather (tank is subject to freezing) In tank with no low temperature alarm:

a. Heating system is operational? Yes No N/A

b. Enclosure of automatic tank fill valve is okay? Yes No N/A

2. Weekly Items during cold weather (in addition to above items)

a. In tank with low temperature alarm, heating system is operational? Yes No N/A

b. If no low temperature alarm, record water temperature (°F):

c. Is above temperature acceptable? Yes No N/A

d. In tank with low temperature alarm, enclosure of automatic tank fill valve okay? Yes No N/A

3. Weekly Items Year Round (in addition to above items)

a. Control valves supervised with seals passed inspection items listed below in Part II.4.h?

Yes No N/A

b. Automatic tank fill valves (not locked or supervised) are open? Yes No N/A

4. Monthly Items (in addition to above items)

a. In tanks with no water level alarm, water level and condition are correct? Yes No N/A

b. In pressure tanks with no supervision, air pressure is correct? Yes No N/A

c. If low temperature alarm, record water temperature (°F):

d. Is above temperature acceptable? Yes No N/A

e. In tanks with locked or supervised automatic tank fill valves, are automatic fill valves open?

Yes No N/A

f. Exterior of automatic fill valve is okay? Yes No N/A

g. Gages: good condition, normal pressure? Yes No N/A

h. Control valves with locks or electrical supervision:

1. In correct open or closed position? Yes No N/A

2. Lock or supervision in place? Yes No N/A

3. Accessible and free from external leaks? Yes No N/A

4. Provided with appropriate wrenches? Yes No N/A

5. Provided with appropriate identification? Yes No N/A

5. Quarterly Items (in addition to above items)

a. In tanks with water level alarms, water level and condition are correct? Yes No N/A

b. In pressure tanks with pressure source supervised, is air pressure correct? Yes No N/A

c. Tank vents clean? Yes No N/A

d. Exterior of tank, support structure, foundation, condition of water in tank, catwalks and ladders, strong and free from obvious damage and ice?

Yes No N/A

e. Area around tank free from combustibles and materials that could accelerate corrosion and ice?

Yes No N/A

f. Strainers, filters and orifices of automatic tank fill valves are clean? Yes No N/A

g. Embankment-Supported Coated-Fabric tanks free from erosion along exterior sides? Yes No N/A

6. Annual Items (in addition to previous items)

a. Interior of automatic tank refill valves that cannot be reset externally okay? Yes No N/A

b. Exterior coated and insulated surfaces of tank and supporting structure free from degradation?

Yes No N/A

c. Expansion joints not leaking or cracking? Yes No N/A

d. Hoops and grills on wooden tanks in acceptable condition? Yes No N/A

63rd Readiness Division Fire Protection Systems

Water Storage Tanks

Form for Periodic Inspection, Testing, and Maintenance

FACID

Building Number

Date of Inspection

8. Fifth Year Inspection Items (in addition to previous items)

a. Check valves internally inspected, all parts operate properly and are in good condition? Yes No N/A

b. Interior of automatic tank refill valves that can be reset externally okay? Yes No N/A

B. Testing - Report any failures in the Comments for this form

1. Monthly Tests (during heating season)

a. Low water temperature alarms passed test? Yes No N/A

b. High temperature limit switch on tank heating system passed test? Yes No N/A

2. Semiannual Tests (in addition to above items)

a. High level water alarm passed test? Yes No N/A

b. Low water level alarm passed test? Yes No N/A

c. Valve supervisory switches indicate movement? Yes No N/A

3. Annual Test - before freezing weather (in addition to above)

a. All control valves operated through full range and returned to normal position? Yes No N/A

b. Tank heating system in proper working order? Yes No N/A

c. Automatic fill valve automatically actuated? Yes No N/A

d. Refill rate:

4. Test for every fifth year (in addition to above items)

a. Level indicators accurate and free to move? Yes No N/A

b. Gages compare to calibrated one or replaced? Yes No N/A

C. Maintenance

1. Regular Maintenance Adjusted, repaired, reconditioned, or replaced components had the associated tests and/or inspections performed?

Yes No N/A

2. Quarterly Maintenance Strainers of automatic refill valves cleaned? Yes No N/A

3. Semiannual Maintenance (in addition to above) Sediment drained or flushed from tank? Yes No N/A

4. Annual Maintenance Items (in addition to above)

a. Operating stem of all OS&Y valves lubricated, completely closed, and reopened? Yes No N/A

b. Cathodic protection maintained in accordance with manufacturer's instructions, all tank drains fully opened then closed, and tank vents cleaned?

Yes No N/A

5. Every Two-Year Maintenance Item (in addition to above) Embankment Supported Coated Fabric tanks cleaned and painted? Yes No N/A

Part III - Comments Any "No" answers, test failures or other problems found with the sprinkler system must be explained using the comment specific for each question. Additional comments can be added here.

Please see the summary section at the top of the form for the comments.

Part IV - Inspector's Information Inspected By I state that the information on this form is correct at the time and place of my inspection, and that all equipment tested at this time was left in operating condition upon completion of this inspection except as noted in the Comments.

Signature of Inspector Date

7. Interior inspection to be performed once every three years on steel tanks without corrosion protection and once every five years on other tanks

a. Interior in good condition with no pitting, corrosion, spalling, rot, deterioration, waste materials, debris, aquatic growth, or failure of interior coating?

Yes No N/A

Yes No N/A Yes No N/A

b. No voids under the floor (ring foundation)?

c. Heating system in good condition?

d. Anti-vortex plates in good condition? Yes No N/A

e. If pitting, corrosion or failure of coating was observed during the interior inspection, was the following performed?

Yes No N/A

Yes No N/A

Yes No N/A Yes No N/A

Yes No N/A

1. Adhesion Test in accordance with ASTM D3359 with acceptable results?

2. Dry film thickness measurements taken to determine coating thickness?

3. Ultrasonic readings for wall thickness?

4. Wet sponge test, no problem with coating?

5. Ultrasonic testing or removal of coupons shows no problem with tank bottom?

6. Vacuum box test on flat bottom tank shows no problem? Yes No N/A