2321 Mayport Rd Dollar Tree Wet Pipe Fire Sprinkler Systems ...
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FORTITUDE
.■. - FIRE PROTECTION -q,
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 watersupply
Owner: Owner Phone Number: Job#:
Owner's Address
Property Being Evaluated: Dollar Tree#5993
Property Address: 2321 Mayport Rd Atlantic Beach FL 32233
Date of Work: 6/2/2021 All responses refer to the current work(inspection,testing and maintenance)performed on this date.
This work is(check one): Monthly [uarterly Annual nThird Year Fifth Year
Part I-Owners Section I 4.Annual Inspection hems(in addition to above items) �.�
A.Is the building occupied? @Yes ONo A.Proper number and type of spare sprinklers? Ones °No @4A
B.Has the occupancy classifcation and hazard of contents rerreined the sane since B.Nsible sprinklers: �/ //t��J
the last inspection? @Yes ONo 1.Free of corrosion and physical damage? Ones Otitis VI-A
2.Free of obstructions to spray patterns? Yes t l/lo v/A
C.Are all fire protection systems in service? (Dees ONo (_,_)No
� 3.Free of foreign materials including paint? Yes A
D.Has the system remained in service without modification since the last inspection? Ones ON'
F�r^N�
Ones 4.Liquid in all glass bulb sprinklers? Yes V ON(q
E.Was the system free of actuation of devices or alarms since the last inspection? Ones Otto C.Visible pipe: /^{��
F.Weekly logs of inupeetiors requred IN fiFPAt25 on fib? ()nes ON0 t.In good condition/no external corrosion? Yes /o ()WA
G.All deficiencies reported at last inspection correc 2.No mechartical damage and no leaks? °Yes t pvn ()WA
opt
@Yes Otto 3.Properly signed and no external bads? v v-
H.By signing 1 knowthe location and understan o eration fad control valves. /�
Laura Johnson 6/2/2021 Visible pipe hangers and seismic braces not damaged or lose? On" O '_ryA
E.Hose,hose couplings and nozzles on sprinkler system passed V tv/
Owner or representative(pnnt name) Signature Date
❑Owner or Owner rep inspection in accordance with PFPA 1962? Oyes ONo OVA
not Onsite F.Adequate heal in areas with wet NOV? Ones °No OVA
Part II-Inspector's Section V
G.Has an internal inspection of the pipe been performed by removing
A Inspections the flushing connection and one sprinkier near the end of a branch ON'
1.Daily and Weekly Items OyV y
ithees (re within last 5 years? GVA
A Cordrol valves supervised with seals in correct(open or closed) (h the answer was"No".conduct an internal inspection.)
position? t - S.Fifth Year Inspection hems(lin addition to above hems) 5 Year Inspection Due: 9/2025
()Yest Mvo �A
8.Backflow Preventers: v A.Alarm valves and their associate strainers,tiers and restriction
1.Valves in correct(open or closed)position? @Yes Ovb OVA orifices passed internal inspection? ONIC Ones ONo ()WA
2.Sealed,locked or supervised&accessible? ()Yes Oto 04/A B.Check valves internally inspected and all parts operate properly,Trove �J�"
3.Reiet port on RPZ device not discharging') Ones Ow �Vje NIA freely and are in good condition? ONC Oven ( .i A
C.For freezer systems,Is the gauge near the compressor reading the `J-'" W B.Testing v
The following tests are to be performed at the noted interval.Report any failures on Part III of this form
sane as the gauge near the dry-pipe valve? Ones OW @4/A
1.Quarterly Tests
2.Monthly Inspection hems(in addition to above items) A.Mechanical water flow alarm devices passed tests by opering the
A Control vis Nes with be its or electrical supervision incorrect(open or /^�'� inspectors test connection or bypass connection with alarms actuating
closed)position? ()Yes Ott ^v"A and flow observed? Ones °No @4A
B.Sprinkler wrench with spare sprinklers? @Yes OW { 4/A B.Post indicating valves opened until sprang or torsion is felt in the rod, V
C.Gauges on wet-pope system in good condition and showing normal v� then closed back one-quarter turn? Ones ONo nyA
water supply pressure? ()Yes Onto OVA C.Main drain test for system downstream of backflow or pressure reducing valve V V
D.Alarm Vetoes. v 1 Record Static Pressure 43 psi and Residual 35 �'
Pressure
Gauges show nom.'supply water pressure,free from physical ❑
See comments-on page 2
damage,valves in correct(open or closed)position and no leakage
from retarding chamber or drains? Ones ONo `f
OVVA 2.Was Flow observed? @Yes OVA
3.Quarterly Inspection Items(in addition to above items)
V 3.Are results s comparable to previous test? @Yes O 'si-I q
2.Semiannual Test(in addition to previous items) '"
A.Pressure Reducing Verve:In open position,not leaking, rrelntainirg A.Valve supervisory switches indicate movement? Ones o nto �J-
A
downstream pressure per design criteria,and in good condition with +� B.Electrical water flow alarm devices passed tests by opening the �J
hand wheel not broken? One' OW OVA inspectors test connection or bypass connection with alarms actuating ��
B.Hydraulic nameplate(calculated systems)securely attached to riser and flow observed? Ones V ( A
and legible? @Yes 0Nn OVA 3.Annual Test(lin addition to previous items) V
C.Fire Department Convection: �,J._ �J- A Main drain test
1.Record Static Pressure psi and Residual Psi
Visible,accessible,coupirgs and swivel not damaged and rotate Pressure
smoothly,plugs or caps in place and undamaged.gaskets in place and ❑
See comments-on page 2
in good condition,identification sign(s)in place,check valve is not
r is inplace and operating 2.Was lbw observed? Oyes ()N/A
leaking,clapper pe ng propery and automatic drain
valve in place and operating properly? @les Cylo OWA 3.Ave resuts comparable to previous test? Ones °No A
(1l plugs or cape are not in place,inspect interior for obstructions.) `;/ �J"' `J� B.We all sprinklers date 1920 or later? OYes o rb Of"
D.Alarm devices free from physical damage? @Yes I� �yA C.Fast response sprinklers 20 or more years oil replaced or successfully 1�
tVJ sample tested witNn last 10 years? Oyes ONo ce,A
Wet Pipe Report page2 ��.,'
D.Standard response sprinklers 50 or more years old replaced or Oyes ONo OVA Partin n-Comments(any"No"answers,test failures
ts noticed
system
V must be explained here.Also,note here any products noticed on the system that have been the
successfully sample tested within last 10 years? subject of a recall ora replacement program.
E.Standard response sprinklers 75 or more years old replaced or
successfully senate tested within last 5 years? Oven ON' O.yA
F.Dry-type sprinkler replaced or successfully sample tested within last
10 years? Oyes ONo aoA
G.Specific gravity of antifreeze correct? OYen ON''
()NIA
H.Al control valves operated through full range and returned to normal
position? Oyes i svo GGA
I.Backflow devices passed backflow test? Cres vONo OWA
Backflow devices passed full flow test? OYes OhioA
K.Pressure reducing valves passed partial flow test? OYes ON'
@VA
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
hFPA 1962.Water discharged and water flow alarms operated? ONC Oyes ON. vim
A
5.Test to be done every 5th year �,J /
A Spnnklers rated above high temperature tested? Oyes ()NoOWA
B.Gauges checked by caibrated gauge or replaced? Oven Oi ivo C>'A
C.Pressure reducing valves passed full flow test? ONC Oven ONo t�Vvay.A
C.Maintenance �,f
1.Regular Maintenance Items
A It sprinklers have been replaced,were they proper replacements? Oven �//:kto /C4.IIA
B.Used hose was cleaned,drained and dried before being placed back in service? ��J
Oven rJo tiro
C.Hose exposed to hazardous materials was disposed of or A''
decontaminated in an approved runner? OYes ■Vyvo C"A
D.Systems normally filled with fresh water were drained and refilled twice if raw
water got into the system? Oyes Ohio ®N/A
E.If any of the following were discovered,was an obstruction investigator
conducted? Oyes Otto O WA
Explain reasons)and obstruction nvestgetion finding in Pan Ill
I.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 veNes,check valves or pumps.
4.Foreign material in water during drain test or plugging of inspectors test connector.
5.Pkigging of ape or spnnlders found during activation or alteration.
6.Failure to flush yard Aping or surrounding pubic mire following new installation or repairs.
7.Record of broken nein in the vicinity.
8.Abrrorrrelly frequent false-tripping of dry-pipe valves. Part IV - Recommendations: Not a part of the NFPA-25 inspection, the following items may need to
be
9.System is returned to service after an extended period out of service(greater than one year). reviewed by a fire protection engineer.
10.There is reason to befeve the system contains sodium siicate or is derivatives or highly Valve seal #00072527203
corrosive fluxes in copper pipe systems.
F.It conditions were found that requred flushing,was flushing of system /.�
conducted? OYes (v No ON/A
2.Annual Maintenance Items lin addition to previous items) v
A Operating stem of all OS&Y valves lubricated completely closed,and ���
re-opened? Oven ONO a�vtWA
B.Sprinklers and spray nozzles protecting commercial cooking equipment C>
VA
ventilating system replaced except for bulb-type which show no
signs of grease buildup? 3Yes No OWA
C.Does there appear to be recalled fire sprinklers installed at this she? Yes 0 No Om
3.Regular Maintenance Items
A.Alarm panel clear? ()Yes 0N OWA
B.System left in service? ()Yes Ohio OW
C.Is system impaired?(Impairment program put into place per FFPA-25 and
Fortitude Fire Protection protocols) Oyes Ohio Part V-Inspector's Information
I state that the information on this loran is correct at the time and place of ay inspection and that all
equpnent tested at this time was left in operational condition upon completion of this inspection except
as noted in Part Ill above.
Date: 6/2/2021
Printed Name of Inspector: Jason Kestner
Signature of Inspector:
License or Certification Number(if applicable): FPI21-000025
Color of tag placed on system: 'Red IIIGreen jfellow
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