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Home My WebLink About40 Kennedy Road - Life Safety System Tes (2) Contractor's Material and Test Certificate for Aboveground Piping 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 shalt be corrected and system left in service before contractor's personnel finally leave the job. A certificate shall be filled out and signed by hnth representatives.Copies shall be pFepaFed for approving autho,ities,owi mrs,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 NAME FEDEX GROUND DATE NOVEMBER 1 2012 PROPERTY ADDRESS 40 KENNEDY ROAD,SOUTH WINDSOR,CT ACCEPTED BY APPROVING AUTHORITIES(NAMES) TOWN OF SOUTH WINDSOR FIRE DEPARTMENT ADDRESS 1175 ELLINGTON STREET SOUTH WINDSOR CT 06074 PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS ®YES ❑ NO EQUIPMENT USED IS APPROVED ®YES ❑ NO IF NO,EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION ®YES ❑ NO OF CONTROL VALVES AND CARE AND MAINTENANCE OF THEIS NEW EQUIPMENT? IF NO,EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES ®YES ❑ NO 1. SYSTEM COMPONENTS INSTRUCTIONS ®YES ❑ NO 2. CARE AND MAINTENANCE INSTRUCTIONS ®YES ❑ NO 3. NFPA 25 ®YES ❑ NO YEAR OF ORIFICE TEMPERATURE MAKE MODEL MANUFACTURE SIZE QUANTITY RATING SPRINKLERS VICTAULIC V3406 2012 3W' 155°F VICTAULIC V3402 2012 314" 155°F VICTAULIC V3401 2012 3/4" 286°F VICTAULIC V3425 2012 314" 231 1 286'F VICTAULIC V3608 2012 3/4" 165°F PIPE AND TYPE OF PIPE BLACK SCHEDULE 10 AND SCHEDULE 40 FITTINGS TYPE OF FITTINGS GROOVED AND THREADED CAST IRON ALARM VALVE MAXIMUM TIME TO OPERATE ALARM DEVICE THROUGH TEST CONNECTION OR TYPE FLOW MAKE MODEL MIN SEC INDICATOR MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. VICTAULIC NXT TIME TO TRIP TIME WATER ALARM DRY PIPE THROUGH TEST WATER AIR TRIP POINT REACHED OPERATED OPERATING CONNECTION PRESSURE PRESSURE MR PRESSURE TEST OUTLET PROPERLY TEST WITH MIN SEC PSI PSI PSI MIN I SEC YES NO � Q.O.D. W/O Q.O.D. IF NO,EXPLAIN OPERATION n PNEUMATIC n ELECTRIC 0 HYDRAULIC PIPING SUPERVISED n YES rl NO DETECTING MEDIA SUPERVISED 1-1 YES fl NO DOES THE VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE DELUGE& CONTROL STATIONS YES NO PREACTION IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT IF NO EXPLAIN VALVES FOR TESTING? M YES r-1 NO , DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO MAKE MODE SUPERVISION-LOSS ALARM OPERATE ALVE RELEASE OPERATE RELEASE YES NO YES NO MIN I SEC PRESSURE LOCATION MAKE& SETTING STATIC PRESSURE RESIDUAL PRESSURE FLOW RATE REDUCING &FLOOR MODEL FLOWING VALVE TEST INLET(PSI) OUTLET(PSI) INLET(PSI) OUTLET(PSI) FLOW(GPM) HYDROSTATIC:Hydrostatic tests shall be made at not less than 200 psi(13.6 bars)for two hours or 50 psi(3.4 bars)above static TEST pressure in excess of 150 psi(10.2 bars)for two hours.Differential dry-pipe valve clappers shall be left open during test to prevent DESCRIPTION damage.All aboveground piping leakage shall be stopped. PNEUMATIC:Establish 40 psi(2.7 bars)air pressure and measure drop,which shall not exceed 1 Y2 psi(0.1 bars)in 24 hours.Test ressure tanks at normal water level and air pressure and measure air pressure dro which shall not exceed 1Y2 psi in 24 hours. ALL PIPING HYDROSTATICALLY TESTED AT 200 PSI FOR 2 HOURS IF NO,STATE REASON DRY PIPINGPNEUMATICALLY TESTED Lj YES N NO EQUIPMENT OPERATES PROPERLY M YES n NO 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? R YES ❑NO DRAIN READING OF GAGE LOCATED NEAR WATER RESIDUAL PRESSURE WITH VALVE IN TEST TESTS TEST SUPPLY TEST CONNECTION PSI CONNECTION OPEN WIDE PSI UNDERGROUND MAINS AND LEAD-IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING. VERIFIED BY COPY OF THE U FORM NO.858 ❑YES ❑NO OTHER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPRINKER PIPING n YES ❑NO IF POWDER DRIVEN FASTENERS ARE USED IN CONCRETE IF NO,EXPLAIN HAS REPRESENTATIVE SAMPLE TESTING BEEN COMPLETED? El YES n NO BLANK TEST NUMBER USED LOCATIONS NUMBER REMOVED GASKETS 0 WELDED PIPING M YES ❑NO IF YES... DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10.9.LEVEL AR 3? ®YES ❑NO DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN COMPLIANCE WELDING WITH THE REQUIREMENTS OF AT LEAST AWS D10.9.LEVEL AR 3? ®YES ❑NO 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 1N PIPING ARE SMOOTH,THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED,AND THAT THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? M YES NO CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS(DISCS) DISCS ARE RETRIEVED? M YES n NO HYDRAULIC NAMEPLATE PROVIDED IF NO,EXPLAIN DATA ®YES ❑NO NAMEPLATE DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN. REMARKS .00 NAME OF SPRINKER CONTRACTOR: MACK FIRE PROTECTION LLC SIGNATURES TESTS WITNESSED BY FOR PROPERTY OWNER(SIGNED) TITLE DATE A FOR WRINKLE2f T (SIGNED) —TJ.T(.E� �- / DATE fr3 i ADDITIONAL EXPLANAT! S ANDWOT S: 1—� �V Cl I Contractor's Material and Test Certificate for Aboveground Piping 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. preparedA GeFtifiGate shall be filled eut and signed by both.eprese,itatives.Coples shall be r 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 NAME FEDEX GROUND DATE NOVEMBER 1 2012 PROPERTY ADDRESS 40 KENNEDY ROAD,SOUTH WINDSOR,CT ACCEPTED BY APPROVING AUTHORITIES(NAMES) TOWN OF SOUTH WINDSOR FIRE DEPARTMENT ADDRESS 1175 ELLINGTON STREET SOUTH WINDSOR CT 06074 PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS ®YES ❑ NO EQUIPMENT USED IS APPROVED ®YES ❑ NO IF NO,EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION ®YES ❑ NO OF CONTROL VALVES AND CARE AND MAINTENANCE OF THEIS NEW EQUIPMENT? IF NO,EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES ®YES ❑ NO 1. SYSTEM COMPONENTS INSTRUCTIONS ®YES ❑ NO 2. CARE AND MAINTENANCE INSTRUCTIONS ®YES ❑ NO 3. NFPA 25 ®YES ❑ NO SUPPLIESLOCATION YEAR OF ORIFICE TEMPERATURE_ MAKE MODEL MANUFACTURE SIZE QUANTITY RATING SPRINKLERS VICTAULIC V3406 2012 314" 155°F VICTAULIC V3402 2012 3/4" 155°F VICTAULIC V3401 2012 3/4" 286*F VICTAULIC V3426 2012 3/4" 217 286°F VICTAULIC V3608 2012 314" 165°F PIPE AND TYPE OF PIPE BLACK SCHEDULE 10 AND SCHEDULE 40 FITTINGS TYPE OF FITTINGS GROOVED AND THREADED CAST IRON MAXIMUM TIME TO OPERATE ALARM VALVE ALARM DEVICE THROUGH TEST CONNECTION OR TYPE MAKE MODEL MIN SEC FLOW INDICATOR MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. VICTAULIC NXT TIME TO TRIP TIME WATER ALARM DRY PIPE THROUGH TEST WATER AIR TRIP POINT REACHED OPERATED OPERATING CONNECTION PRESSURE PRESSURE LIR PRESSURE TEST OUTLET PROPERLY TEST MIN SEC PSI PSI PSI MIN SEC YES NO WITH -7 I } Q.O.D. W/O Q.O.D. IF NO,EXPLAIN OPERATION PNEUMATIC n ELECTRIC El HYDRAULIC PIPING SUPERVISED 1-1 YES 11 NO DETECTING MEDIA SUPERVISED n YES rl NO DOES THE VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE DELUGE& CONTROL STATIONS YES NO PREACTION 1S THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT IF NO,EXPLAIN VALVES FOR TESTING? n YES [1 NO DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO MAKE MODEI SUPERVISION LOSS ALARM OPERATE VALVE RELEASE OPERATE RELEASE YES NO YES I NO MIN SEC PRESSURE LOCATION MAKE& SETTING STATIC PRESSURE RESIDUAL PRESSURE FLOW RATE REDUCING &FLOOR MODEL FLOWING VALVE TEST INLET(PSI) OUTLET(PSI) INLET(PSI) OUTLET(PSI) FLOW(GPM) HYDROSTATIC:Hydrostatic tests shall be made at not less than 200 psi(13.6 bars)for two hours or 50 psi(3.4 bars)above static TEST pressure in excess of 150 psi(10.2 bars)for two hours.Differential dry-pipe valve clappers shall be left open during test to prevent DESCRIPTION damage.All aboveground piping leakage shall be stopped. PNEUMATIC:Establish 40 psi(2.7 bars)air pressure and measure drop,which shall not exceed 1 Y psi(0.1 bars)in 24 hours.Test ressure tanks at normal water level and air oressure and measure air pressure drop which shall not exceed V/2 psi in 24 hours. ALL PIPING HYDROSTATICALLY TESTED AT 200PAIFOR21-101-IRS IF NO,STATE REASON DRY PIPING PNEUMATICALLY TESTED ❑YES ®NO EQUIPMENT OPERATES PROPERLY ®YES ❑NO 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? ®YES ❑NO DRAIN READING OF GAGE LOCATED NEAR WATER RESIDUAL PRESSURE WITH VALVE IN TEST TESTS TEST SUPPLY TEST CONNECTION PSI CONNECTION OPEN WIDE PSI UNDERGROUND MAINS AND LEAD-IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING. VERIFIED BY COPY OF THE U FORM NO.858 ❑YES ❑NO OTHER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPRINKER PIPING ❑YES I-lNO IF POWDER DRIVEN FASTENERS ARE USED IN CONCRETE IF NO,EXPLAIN HAS REPRESENTATIVE SAMPLE TESTING BEEN COMPLETED? n YES n NO BLANK TEST NUMBER USED LOCATIONS NUMBER REMOVED GASKETS 0 WELDED PIPING M YES ❑NO IF YES... DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10.9.LEVEL AR 3? ®YES ❑NO DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN COMPLIANCE WELDING WITH THE REQUIREMENTS OF AT LEAST AWS D10.9.LEVEL AR 3? ®YES ❑NO 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? YES NO CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS(DISCS) DISCS ARE RETRIEVED? YES NO HYDRAULIC NAMEPLATE PROVIDED IF NO,EXPLAIN DATA ®YES ❑NO NAMEPLATE DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN. REMARKS NAME OF SPRINKER CONTRACTOR: MACK FIRE PROTECTION LLC �� t SIGNATURES TES119WITNESSED BY FOR PROP!�WN I ) TITLE a DATE i N Z FOR SPRI LER N T (SIGN TITLE DATE / f Oet&A / 01 ADDITIONAL EXPLANATIONS 1AND NOTES: Contractor's Material and Test Certificate for Aboveground Piping PROCEDURE I Innn 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 eave a to . 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 NAME FEDEX GROUND I DATE NOVEMBER 1 2012 PROPERTY ADDRESS 40 KENNEDY ROAD,SOUTH WINDSOR,CT ACCEPTED BY APPROVING AUTHORITIES(NAMES) TOWN OF SOUTH WINDSOR FIRE DEPARTMENT ADDRESS 1176 ELLINGTON STREET SOUTH WINDSOR CT 06074 PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS 0 YES ONO ®YES ❑ NO EQUIPMENT USED IS APPROVED IF NO,EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION ®YES ❑ NO OF CONTROL VALVES AND CARE AND MAINTENANCE OF THEIS NEW EQUIPMENT? IF NO,EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES ®YES ❑ NO 1. SYSTEM COMPONENTS INSTRUCTIONS ®YES ❑ NO 2. CARE AND MAINTENANCE INSTRUCTIONS ®YES ❑ NO 3. NFPA 25 ®YES ❑ NO LOCATION SUPPLIES BUILDINGS ZOI IF 93 YEAR OF ORIFICE TEMPERATURE MAKE MODEL MANUFACTURE SIZE QUANTITY RATING SPRINKLERS VICTAULIC V3406 2012 3/4" 83 155"F VICTAULIC V3402 2012 3/4" 155°F VICTAULIC V3401 2012 314" 38 286'F VICTAULIC I V3426 2012 3WI 81 286'F VICTAULIC I V3608 2012 3/4" 1 165"F PIPE AND TYPE OF PIPE BLACK SCHEDULE 10 AND SCHEDULE 40 FITTINGS TYPE OF FITTINGS GROOVED AND THREADED CAST IRON MAXIMUM TIME TO OPERATE ALARM VALVE ALARM DEVICE THROUGH TEST CONNECTION OR TYPE MAKE MODEL MIN SEC FLOW INDICATOR MAKE MODEL SERIAL NO. MAKE I MODEL SERIAL NO. VICTAULIC NXT TIME TO TRIP TIME WATER ALARM DRY PIPE THROUGH TEST WATER AIR TRIP POINT REACHED OPERATED OPERATING CONNECTION PRESSURE PRESSURE AIR PRESSURE TEST OUTLET PROPERLY TEST MIN I SEC I PSI PSI PSI MIN SEC YES JNO WITH I Q.O.D. t L L. W/O Q.O.D. IF NO,EXPLAIN OPERATION ❑PNEUMATIC ❑ELECTRIC ❑HYDRAULIC PIPING SUPERVISED ❑YES ❑NO DETECTING MEDIA SUPERVISED ❑YES ❑NO DOES THE VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE ❑YES ❑NO DELUGE& CONTROL STATIONS PREACTION IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT IF NO,EXPLAIN VALVES FOR TESTING? ❑YES ❑NO DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO MAKE MODE SUPERVISION LOSS ALARM OPERATE VALVE RELEASE OPERATE RELEASE YES NO YES NO MIN 1 SEC PRESSURE LOCATION MAKE& SETTING STATIC PRESSURE RESIDUAL OWINGSSURE FLOW RATE REDUCING &FLOOR MODEL VALVE TEST INLET(PSI) OUTLET(PSI) INLET(PSI) OUTLET(PSI) FLOW(GPM) r HYDROSTATIC:Hydrostatic tests shall be made at not less than 200 psi(13.6 bars)for two hours or 50 psi(3.4 bars)above static TEST pressure in excess of 150 psi(10.2 bars)for two hours.Differential dry-pipe valve clappers shall be left open during test to prevent DESCRIPTION damage.All aboveground piping leakage shall be stopped. PNEUMATIC:Establish 40 psi(2.7 bars)air pressure and measure drop,which shall not exceed 1'/psi(0.1 bars)in 24 hours.Test ressure tanks at normal water level and air twessure and measure air messure drop which shall not exceed 1% si in 24 hours. Al I PIPING ALLY TESTED AT 200 PSI FOR 2 HOURS IF NO,STATE REASON DRY PIPING PNEUMATICALLY TESTED ❑YES ®NO EQUIPMENT OPERATES PROPERLY ®YES ❑NO 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? M YES rl NO DRAIN READING OF GAGE LOCATED NEAR WATER RESIDUAL PRESSURE WITH VALVE IN TEST TESTS TEST SUPPLY TEST CONNECTION PSI CONNECTION OPEN WIDE PSI UNDERGROUND MAINS AND LEAD-IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING. VERIFIED BY COPY OF THE U FORM NO.858 ❑YES ❑NO OTHER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPRINKER PIPING ❑YES ❑NO IF POWDER DRIVEN FASTENERS ARE USED IN CONCRETE IF NO,EXPLAIN HAS REPRESENTATIVE SAMPLE TESTING BEEN COMPLETED? YES F1NO BLANK TEST NUMBER USED LOCATIONS NUMBER REMOVED GASKETS 0 WELDED PIPING M YES ❑NO IF YES... DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10.9.LEVEL AR 3? ®YES ❑NO DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN COMPLIANCE WELDING WITH THE REQUIREMENTS OF AT LEAST AWS D10.9.LEVEL AR 3? ®YES ❑NO 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? M YES n NO CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS(DISCS) DISCS ARE RETRIEVED? YES NO HYDRAULIC NAMEPLATE PROVIDED IF NO,EXPLAIN DATA ®YES ❑NO NAMEPLATE DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN. REMARKS NAME OF SPRINKER CONTRACTOR: f �Z MACK FIRE PROTECTION LLC SIGNATURES TESTS WPtNFSSED B FOR PROP RT R TITLE DATE !� J FOR SPRI_, LE R(. D} DATE I ADDITIONAL EXPLANATIONS AND NOTES: r - i - Contractor's Material and Test Certificate for Aboveground Piping PROCEDURE Upon completion of work,inspection and tests shall be made by the Contractors 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. sand contractor.It is certificate shall 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 NAME FEDEX GROUND DATE NOVEMBER 1 2012 PROPERTY ADDRESS 40 KENNEDY ROAD,SOUTH WINDSOR,CT ACCEPTED BY APPROVING AUTHORITIES(NAMES) TOWN OF SOUTH WINDSOR FIRE DEPARTMENT ADDRESS 1175 ELLINGTON STREET SOUTH WINDSOR CT 06074 PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS ®YES ❑ NO EQUIPMENT USED IS APPROVED IF NO,EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION ®YES ❑ NO OF CONTROL VALVES AND CARE AND MAINTENANCE OF THEIS NEW EQUIPMENT? IF NO,EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES ®YES ❑ NO 1. SYSTEM COMPONENTS INSTRUCTIONS ®YES ❑ NO 2. CARE AND MAINTENANCE INSTRUCTIONS ®YES ❑ NO 3. NFPA 25 ®YES ❑ NO LOCATION SUPPLIES BUILDINGS YEAR OF ORIFICE TEMPERATURE MAKE MODEL MANUFACTURE SIZE QUANTITY RATING SPRINKLERS VICTAULIC V3406 2012 3/4" 21 155"F VICTAULIC V3402 2012 3/4" 1 155°F VICTAULIC V3401 2012 3/4" 286`F VICTAULIC V3426 2012 3/4" 192 165°F VICTAULIC V3608 2012 3/4' PIPE AND TYPE OF PIPE BLACK SCHEDULE 10 AND SCHEDULE 40 FITTINGS TYPE OF FITTINGS GROOVED AND THREADED CAST IRON MAXIMUM TIME TO OPERATE ALARM VALVE ALARM DEVICE THROUGH TEST CONNECTION OR TYPE MAKE MODEL MIN SEC FLOW INDICATOR MAKE- MODEL SERIAL NO. MAKE MODE SERIAL NO. VICTAULIC NXT TIME WATER ALARM TIME TO TRIP DRY PIPE THROUGH TEST WATER AIR RIP POINT REACHED OPERATED OPERATING CONNECTION PRESSURE PRESSURE IR PRESSURE TEST OUTLET PROPERLY TEST MIN SEC PSI PSI PSI MIN SEC YES NO WITH ` r r Q.O.D. W/O Q.O.D. IF NO,EXPLAIN OPERATION ❑PNEUMATIC ❑ELECTRIC ❑HYDRAULIC PIPING SUPERVISED ❑YES ❑NO DETECTING MEDIA SUPERVISED ❑YES ❑NO DOES THE VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE ❑YES ❑NO DELUGE& CONTROL STATIONS PREACTION IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT IF NO,EXPLAIN VALVES FOR TESTING? ❑YES ❑NO DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO MAKE MODE SUPERVSSEO LOSS ALARM OPERATE ALVE RELEASE OPERATE RELEASE YES NO YES NO MIN SEC PRESSURE LOCATION MAKE& SETTING STATIC PRESSURE RESIDUAL L R�SSURE FLOW RATE REDUCING &FLOOR MODEL VALVE TEST INLET(PSI) OUTLET(PSI) INLET(PSI) OUTLET(PSI) FLOW(GPM) HYDROSTATIC:Hydrostatic tests shall be made at not less than 200 psi(13.6 bars)for two hours or 50 psi(3.4 bars)above static TEST pressure in excess of 150 psi(10.2 bars)for two hours.Differential dry-pipe valve clappers shall be left open during test to prevent DESCRIPTION damage.All aboveground piping leakage shall be stopped. PNEUMATIC:Establish 40 psi(2.7 bars)air pressure and measure drop,which shall not exceed 1'/psi(0.1 bars)in 24 hours.Test pressure tanks at normal water level and air oressure and measure air pressure droo which shall not exceed 1'/z psi in 24 hours. 1DROSTATICALLY TESTED AT 200 PSI FOR 2 HOURS IF NO,STATE REASON DRY PIPING PNEUMATICALLY TESTED YES N NO EQUIPMENT OPERATES PROPERLY ®YES ❑NO 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? ®YES ❑NO DRAIN READING OF GAGE LOCATED NEAR WATER RESIDUAL PRESSURE WITH VALVE IN TEST TESTS TEST SUPPLY TEST CONNECTION PSI CONNECTION OPEN WIDE PSI UNDERGROUND MAINS AND LEAD-IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING. VERIFIED BY COPY OF THE U FORM NO.858 ❑YES ❑NO OTHER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPRINKER PIPING ❑YES ❑NO IF POWDER DRIVEN FASTENERS ARE USED IN CONCRETE IF NO,EXPLAIN HAS REPRESENTATIVE SAMPLE TESTING BEEN COMPLETED? n YES n NO BLANK TEST NUMBER USED LOCATIONS NUMBER REMOVED GASKETS 0 WELDED PIPING ®YES ❑NO IF YES... DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10.9.LEVEL AR 3? ®YES ❑NO DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN COMPLIANCE WELDING WITH THE REQUIREMENTS OF AT LEAST AWS D10.9.LEVEL AR 3? ®YES El NO 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 YES n NO THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS(DISCS) YES NO DISCS ARE RETRIEVED? IF NO,EXPLAIN HYDRAULIC NAMEPLATE PROVIDED ®YES ❑NO DATA NAMEPLATE DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN. REMARKS NAME OF SPRINKER CONTRACTOR- MACK FIRE PROTECTION LLC SIGNATURES STS TNESSED BY FOR PROP R SI ' D) TITLE/ DATE n FOR SPR1 L R R TITLE _ DATE ADDITIONAL EXPLANATIONS AND NOTES: t� a Contractor's Material and Test Certificate for Aboveground Piping 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 GeFtifiGate shall be filled out and signed by both representatives Copies shall hp prep;ired for appmving authoriflt-q,owners and contractor,It 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 NAME FEDEX GROUND DATE NOVEMBER 1,2012 PROPERTY ADDRESS 40 KENNEDY ROAD,SOUTH WINDSOR,CT ACCEPTED BY APPROVING AUTHORITIES(NAMES) TOWN OF SOUTH WINDSOR FIRE DEPARTMENT ADDRESS 1175 ELLINGTON STREET, SOUTH WINDSOR CT 06074 PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS ®YES ❑ NO EQUIPMENT USED IS APPROVED ®YES ❑ NO IF NO,EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION ®YES ❑ NO OF CONTROL VALVES AND CARE AND MAINTENANCE OF THEIS NEW EQUIPMENT? IF NO,EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES ®YES ❑ NO 1. SYSTEM COMPONENTS INSTRUCTIONS ®YES ❑ NO 2. CARE AND MAINTENANCE INSTRUCTIONS ®YES ❑ NO 3. NFPA 25 ®YES ❑ NO LOCATIONL YEAR OF ORIFICE TEMPERATURE MAKE MODEL MANUFACTURE SIZE QUANTITY RATING SPRINKLERS VICTAULIC V3406 2012 3W- 155°F VICTAULIC V3402 2012 3/4" 155°F VICTAULIC V3401 2012 3/4" 286"F VICTAULIC V3426 2012 3/4" 231 286°F VICTAULIC V3608 2012 3/4" 4 165°F PIPE AND TYPE OF PIPE BLACK SCHEDULE 10 AND SCHEDULE 40 FITTINGS TYPE OF FITTINGS GROOVED AND THREADED CAST IRON MAXIMUM TIME TO OPERATE ALARM VALVE ALARM DEVICE THROUGH TEST CONNECTION OR TYPE MAKE MODEL MIN SEC FLOW INDICATOR --4- MAKE MODEL SERIAL NO. MAKE MODE SERIAL NO. VICTAULIC NXT TIME TO TRIP TIME WATER ALARM DRY PIPE THROUGH TEST WATER AIR TRIP POINT REACHED OPERATED OPERATING CONNECTION PRESSURE PRESSURE AIR PRESSURE TEST OUTLET PROPER TEST MIN I SEC - PSI PSI PSI MIN SEC YES NO WITH L Q.O.D. W/O Q.O.D. IF NO,EXPLAIN OPERATION F1 PNEUMATIC M ELECTRIC Fl HYDRAULIC PIPING SUPERVISED n YES ❑NO DETECTING MEDIA SUPERVISED Fl YES ❑NO DOES THE VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE DELUGE& CONTROL STATIONS ❑YES ❑NO PREACTION IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT IF NO,EXPLAIN VALVES FOR TESTING? ❑YES F I NO DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO MAKE MODE SUPERVSSEO LOSS ALARM OPERATE ALVE RELEASE OPERATE RELEASE YES NO YES NO MIN I SEC PRESSURE LOCATION MAKE& SETTING STATIC PRESSURE RESIDUAL PRESSURE FLOW RATE REDUCING &FLOOR MODEL (FLOWING) VALVE TEST INLET(PSI) OUTLET(PSI) INLET(PSI) OUTLET(PSI) FLOW(GPM) 1 HYDROSTATIC:Hydrostatic tests shall be made at not less than 200 psi(13.6 bars)for two hours or 50 psi(3.4 bars)above static TEST pressure in excess of 150 psi(10.2 bars)for two hours.Differential dry-pipe valve clappers shall be left open during test to prevent DESCRIPTION damage.All aboveground piping leakage shall be stopped. PNEUMATIC:Establish 40 psi(2.7 bars)air pressure and measure drop,which shall not exceed 1%psi(0.1 bars)in 24 flours.Test ressure tanks at normal water level and air vessure and measure air pressure drop which shall not exceed IY2 psi in 24 hours. ALL PIPING HYDROSTATICALLY TESTED AT 200 PSI FOR 2 HOURS IF NO,STATE REASON DRY PIPING PNEUMATICALLY TESTED EQUIPMENT OPERATES PROPERLY ®YES ❑NO 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? ®YES ❑NO DRAIN READING OF GAGE LOCATED NEAR WATER RESIDUAL PRESSURE WITH VALVE IN TEST TESTS TEST SUPPLY TEST CONNECTION PSI CONNECTION OPEN WIDE PSI UNDERGROUND MAINS AND LEAD-IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING. VERIFIED BY COPY OF THE U FORM NO.858 ❑YES ❑NO OTHER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPRINKER PIPING ❑YES FIND IF POWDER DRIVEN FASTENERS ARE USED IN CONCRETE IF NO,EXPLAIN HAS REPRESENTATIVE SAMPLE TESTING BEEN COMPLETED? YES n NO BLANK TEST NUMBER USED LOCATIONS NUMBER REMOVED GASKETS 0 WELDED PIPING YES NO IF YES... DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10.9.LEVEL AR 3? ®YES ❑NO DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN COMPLIANCE WELDING WITH THE REQUIREMENTS OF AT LEAST AWS D10.9.LEVEL AR 3? ®YES NO 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 YES n NO THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS(DISCS) YES n NO DISCS ARE RETRIEVED? IF NO,EXPLAIN HYDRAULIC NAMEPLATE PROVIDED ®YES ❑NO DATA NAMEPLATE DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN. REMARKS NAME OF SPRINKER CONTRACTOR: pr0! Z MACK FIRE PROTECTION LLC SIGNATURES TES S WITNESSED BY FOR PROPERTY 0 {R(SIG ED TITLE DATE FOR LrjP,,I C (SIGNE ADDITIONAL EXPLANATIONS NDGG�'NOTES: /V