2321 MAYPORT Dollar Tree #5993 Quarterly 2-28-23 2430 University Blvd W. * Jacksonville, FL 32217 * 904-733-9008 www.fortitudefire.com
NFPA-25 Inspection, Testing and Maintenance of Wet Pipe Fire Sprinkler Systems
Information on this form covers the minimum requirements of NFPA 25 for fire sprinkler systems connected to distribution systems without supplemental tanks or fire pumps. 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 occupancy and the water supply.
Owner: Owner Phone Number: Job #:
Owner's Address:
Property Being Evaluated:
Property Address:
Date of Work: All responses refer to the current work (inspection, testing and maintenance) performed on this date.
This work is (check one): Monthly Quarterly Annual Third Year Fifth Year
Part I - Owner's Section 4. Annual Inspection Items (in addition to above items)
A.Is the building occupied?
B.Has the occupancy classification and hazard of contents remained the same since
Yes No A.Proper number and type of spare sprinklers?
B.Visible sprinklers:
Yes No N/A
the last inspection?
C.Are all fire protection systems in service?
D.Has the system remained in service without modification since the last inspection?
E.Was the system free of actuation of devices or alarms since the last inspection?
F.Weekly logs of inspections required by NFPA#25 on file?
G.AlI deficiencies reported at last inspection corrected?
H.By signing I know the location and understand the operation of all control valves.
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
1.Free of corrosion and physical damage?Yes No N/A
2.Free of obstructions to spray patterns? Yes No N/A
3.Free of foreign materials including paint?Yes No N/A
4.Liquid in all glass bulb sprinklers?Yes No N/A
C.Visible pipe:
1.In good condition/no external corrosion?Yes No N/A
2.No mechanical damage and no leaks? Yes No N/A
3.Properly aligned and no external loads?
D.Visible pipe hangers and seismic braces not damaged or lose? Yes No N/A
E. Hose, hose couplings and nozzles on sprinkler system passed
Owner or representative (print name) Signature
Part II - Inspector's Section
A. Inspections
1.Daily and Weekly Items
A.Control valves supervised with seals in correct (open or closed)
position?
B.Backflow Preventers:
Date Owner or Owner rep. not onsite
Yes No N/A
inspection in accordance with NFPA 1962? Yes No N/A
F.Adequate heat in areas with wet piping?Yes No N/A
G.Has an internal inspection of the pipe been performed by removing
the flushing connection and one sprinkler near the end of a branch
line within the last 5 years? Yes No N/A
(If the answer was "No", conduct an internal inspection.)
5.Fifth Year Inspection Items (in addition to above items) 5 Year Inspection Due:
A. Alarm valves and their associate strainers, filters and restriction
1.Valves in correct (open or closed) position?
2.Sealed, locked or supervised & accessible?
3.Relief port on RPZ device not discharging?
C. For freezer systems, is the gauge near the compressor reading the
Yes No N/A
Yes No N/A
Yes No N/A
orifices passed internal inspection?
B. Check valves internally inspected and all parts operate properly, move
freely and are in good condition?
B. Testing
NIC Yes No N/A
NIC Yes No N/A
same as the gauge near the dry-pipe valve?
2.Monthly Inspection Items (in addition to above items)
A. Control valves with locks or electrical supervision in correct (open or
Yes No N/A The following tests are to be performed at the noted intervals. Report any failures on Part III of this form.
1.Quarterly Tests
A. Mechanical water flow alarm devices passed tests by opening the
inspector's test connection or bypass connection with alarms actuating closed) position? Yes No N/A
B.Sprinkler wrench with spare sprinklers? Yes No N/A
C.Gauges on wet-pipe system in good condition and showing normal
water supply pressure? Yes No N/A
and flow observed? Yes No N/A
B. Post indicating valves opened until spring or torsion is felt in the rod,
then closed back one-quarter turn? Yes No N/A
C.Main drain test for system downstream of backflow or pressure reducing valve:
D.Alarm Valves:
Gauges show normal supply water pressure, free from physical
damage, valves in correct (open or closed) position and no leakage
from retarding chamber or drains? Yes No N/A
3.Quarterly Inspection Items (in addition to above items)
A.Pressure Reducing Valve: In open position, not leaking, maintaining
downstream pressure per design criteria, and in good condition with
hand wheels not broken? Yes No N/A
B.Hydraulic nameplate (calculated systems) securely attached to riser
and legible? Yes No N/A
C. Fire Department Connection:
Visible, accessible, couplings and swivels not damaged and rotate
smoothly, plugs or caps in place and undamaged, gaskets in place and
in good condition, identification sign(s) in place, check valve is not
leaking, clapper is in place and operating properly and automatic drain
valve in place and operating properly? Yes No N/A
(If plugs or caps are not in place, inspect interior for obstructions.)
D.Alarm devices free from physical damage?Yes No N/A
1.Record Static Pressure psi and Residual Pressure
See comments - on page 2
2.Was flow observed?
3.Are results comparable to previous test?
2.Semiannual Test (in addition to previous items)
A. Valve supervisory switches indicate movement?
B. Electrical water flow alarm devices passed tests by opening the
inspector's test connection or bypass connection with alarms actuating
and flow observed?
3.Annual Test (in addition to previous items)
A.Main drain test: 1.Record Static Pressure psi and Residual Pressure
See comments - on page 2
2. Was flow observed?
3. Are results comparable to previous test?
B.Are all sprinklers date 1920 or later?
C. Fast response sprinklers 20 or more years old replaced or successfully
sample tested within last 10 years?
psi
Yes
Yes
No
No
N/A
N/A
Yes No N/A
Yes No N/A
psi
Yes No N/A
Yes
Yes
Yes
No
No
No
N/A
N/A
N/A
Commercial Fire 4859929
Dollar Tree #5993
2321 Mayport Rd, Atlantic Beach, Fl 32233
2-28-2023
2-28-2023
45 36
Joseph Williams
✔
Wet Pipe Report page 2
D. Standard response sprinklers 50 or more years old replaced or
successfully sample tested within last 10 years?
E. Standard response sprinklers 75 or more years old replaced or
successfully sample tested within last 5 years?
F. Dry-type sprinkler replaced or successfully sample tested within last
Yes No N/A
Yes No N/A
Part III - Comments (any "No" answers, test failures or other problems found with the sprinkler system must be explained here. Also, note here any products noticed on the system that have been the subject of a recall or a replacement program.
10 years? Yes No N/A G. Specific gravity of antifreeze correct? Yes No N/A H. All control valves operated through full range and returned to normal
position?
Yes No N/A
I. Backflow devices passed backflow test? Yes No N/A
J. Backflow devices passed full flow test? Yes No N/A K. Pressure reducing valves passed partial flow test? Yes No N/A
4. Test to be done every third year: Hose (more than 5 years old) connected to the system has been service tested in accordance with
NFPA 1962. Water discharged and water flow alarms operated?
5. Test to be done every 5th year
NIC Yes No N/A
A. Sprinklers rated above high temperature tested? Yes No N/A
B. Gauges checked by calibrated gauge or replaced? Yes No N/A C. Pressure reducing valves passed full flow test?
C. Maintenance
1. Regular Maintenance Items
NIC Yes No N/A
A. If sprinklers have been replaced, were they proper replacements? B. Used hose was cleaned, drained and dried before being placed back in service?
Yes
Yes
No
No
N/A
N/A C. Hose exposed to hazardous materials was disposed of or
decontaminated in an approved manner?
Yes
No
N/A
D. Systems normally filled with fresh water were drained and refilled twice if raw
water got into the system? Yes No N/A E. If any of the following were discovered, was an obstruction investigation
conducted? Yes No N/A
Explain reason(s) and obstruction investigation finding in Part III 1. Defective intake screen on pump with suction from open sources. 2. Obstructive material discharged during water flow tests. 3. Foreign materials found in dry-pipe valves, check valves or pumps. 4. Foreign material in water during drain test or plugging of inspector's test connection. 5. Plugging of pipe or sprinklers found during activation or alteration. 6. Failure to flush yard piping or surrounding public mains following new installation or repairs. 7. Record of broken mains in the vicinity.
8. Abnormally frequent false-tripping of dry-pipe valves.
9. System is returned to service after an extended period out of service (greater than one year).
10. There is reason to believe the system contains sodium silicate or its derivatives or highly
corrosive fluxes in copper pipe systems.
F. If conditions were found that required flushing, was flushing of system
conducted? Yes No N/A
2. Annual Maintenance Items (in addition to previous items)
A. Operating stem of all OS&Y valves lubricated completely closed, and
re-opened? Yes No N/A
B. Sprinklers and spray nozzles protecting commercial cooking equipment
Fortitude Fire Protection protocols) Yes No
Part IV - Recommendations: Not a part of the NFPA-25 inspection, the following items may need to be reviewed by a fire protection engineer.
Part V - Inspector's Information
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 operational condition upon completion of this inspection except
as noted in Part III above.
Date:
Printed Name of Inspector:
Signature of Inspector:
License or Certification Number (if applicable):
Color of tag placed on system: Red Green Yellow
and ventilating systems replaced except for bulb-type which show no
signs of grease buildup?
Yes
No
N/A
C. Does there appear to be recalled fire sprinklers installed at this site? Yes No N/A
3. Regular Maintenance Items
A. Alarm panel clear?
Yes
No
N/A
B. System left in service? Yes No N/A
C. Is system impaired? (Impairment program put into place per NFPA-25 and
Valve seal #0010931, 0010932
2-28-2023
Jason Smith
FPI22-000325
✔
Fortitude Fire Protection, LLC (904)733-9008
Jason Smith FPI 22-000325
Dollar Tree #5993
2321 Mayport Rd
(1) Wet
None
None
None
Quarterly
2-28-2023 2-28-2023
Atlantic Beach 32233