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HomeMy WebLinkAbout40 Kennedy Road - Life Safety System Tes (3) 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 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 Fed Ex Ground DATE PROPERTY ADDRESS 40 Kennedy Road,South Windsor,CT 06074 ACCEPTED BY APPROVING AUTHORITIES(NAMES)Town of South Windsor ADDRESS 1540 Sullivan Avenue 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 LOCATION Co e s zz YEAR OF ORIFICE TEMPERATURE MAKE MODEL MANUFACTURE SIZE QUANTITY RATING SPRINKLERS Victaullc V3401 2013 8.0K 237 166 PIPE AND TYPE OF PIPE Black Steel FITTINGS TYPE OF FITTINGS Black Cast-iron MAXIMUM TIME TO OPERATE ALARM VALVE ALARM DEVICE THROUGH TEST CONNECTION OR TYPE I MAKE I MODEL MIN SEC FLOW INDICATOR MAKE MODEL I SERIAL NO. MAKE MODE SERIAL NO. Victaullc Firelock 768NXT TIME TO TRIP TIME WATER ALARM DRY PIPE THROUGH TEST WATER AIR :RIP POINT REACHED OPERATED OPERATING CONNECTIO PRESSURE PRESSURE iR PRESSURE TEST OUTLET PROPERLY TEST MIN SEC`' PSI 13SF r,.PSI r .MIN SEC ES - O WITH Q.O.D. W/O Q.O.D. IF NO,EXPLAIN OPERATION ❑PNEUMATIC n ELECTRIC I l HYDRAULIC PIPING SUPERVISED ❑YES ❑NO DETECTING MEDIA SUPERVISED n YES rl NO DOES THE VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE DELUGE& CONTROL STATIONS rl YES rl NO PRERCTION IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT IF NO,EXPLAIN VALVES EOR TESTING? YES rl NO DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO MAKE MODE SUPERVISEO LOSS ALARM OPERATE VALVE RELEASE OPE TE 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 OU LET 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 V psi(0.1 bars)in 24 hours.Test r ssure tans at normal water level and air ressure and measure air Pressure drop which shall not exceed IY2 psi in 24 hours. ALL PIPING HYDROSTATICALLY TESTED AT FOR 2 HOURS IF NO,STATE REASON DRY PIPING PNEUMATICALLY TESTED ❑YES ❑NO EQUIPMENT OPERATES PROPERLY 0 YES ©NO DO YOU CERTIFYAS 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 r l 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 [1NO IF POWDER DRIVEN FASTENERS ARE USED IN CONCRETE IF NO,EXPLAIN HAS REPRESENTATIVE SAMPLE TESTING BEEN COMPLETED? rl YES N BLANK TEST NUMBER USED LOCATIONS NUMBER REMOVED GASKETS 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 U (lrs SIGNATURES TESTS WITNESSED BY FOR.PROPERTY OWNER(SIGNED) TITLE DATE;r F NKLE s. RACTOR(SIGNED) T TLC DATE ADDITIONAL EXPLANArTtONS AND NOTES: � -