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2321 Mayport Rd Dollar Tree Fire Sprinkler rrwP FDRTITUDE FIRE PROTECTION —(g 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: 8)4/2021 All responses refer to the current work(inspection,testing and maintenance)performed on this date. This work is(check one): Monthly F-1Quarterly ✓Annual Third Year Fifth Year Part I-Owner's Section 4.Annual Inspection Bents(in addition to above items) A.Is the building occupied? *Yes ONO A.Proper number and type of spare sprinklers? (yes ONo OVA B.Has the occupancy classification and hazard of contents remained the same since B.Visible sprinklers: V VV the last inspection? *Yes *No 1.Free of corrosion and physical damage? *Yes OONO OµA C.Are all fire O O 2.Free of obstructions to spray patterns' Yes E oro (�YA protection systems in service? Yes trio l(y^^� /<S"(J�,�Ir' O1'es O� 3 Free of foreign materials including paint? Cres A D.Has the system refrained in service without modification since the last inspection? V V 4 Liquid in all glass bulb sprinklers? fSYes q E.Was the system free of actuation of devices or alarms since the last inspection? *Yes ONo C.Visible pipe. V F.Weekly logs of inspections required by NFPA#25 on file? 1.In good condition/no external corrosion? Oyes Otto ` 4/A *Vias ©No 2.No mechanical darts a and no leaks? ®Yes ()No V G.All deficiencies reported at last inspection corrected? 9 �A H.By signing I know the location and understand the operati t all control valves. *Yos ONo 3 Property aigned and no external loads? �z D Vsibe p pe hangers and selmc braces not damaged or lose? 8/4/2021 V ()Yes ONo ` 4/A E.Hose,hose couplings and nozzles on sprinkler system passed `VV Owner or representative(print name) Signature Date �'' 0 Owner or Owner rep inspection in accordance with NFPA 1962? Oyes ONO I�aWA not onsite F.Adequate heat in areas with wet piping? ®Yes ONo VvA Part II-Inspector's Section G.Has an internal inspection of the pipe been performed by removing `J A Inspections the flushing connection and one sprinkler near the end of a branch 1.Daily and Weekly Items fine within the last 5 years? (Yes Otto `v diA A.Control valves supervised with seals in correct(open or closed) (If the answer was No conduct an internal inspection.) position? ^' 5.Fifth Year Inspection Items(in addition to above items) 5 Year Inspection Due: 9/2025 OYes ' No OVA B.Backflow Presenters v t/ A.Alarm valves and their associate strainers,filters and restnction 1.Valves in correct(open or closed)position? ()Yes ONo OVA orifices passed internal inspection? ONC OYes ONo /�'1ra.A 2.Sealed,locked or supervised&accessible? OYes OW ('}4lA B.Check valves internally inspected and at parts operate property,Trove ONC �� �VJ4 freely and are in good condifion? NC Yes NO ®'l/ 3.Reief porton RPZ device not discharging? (Yes OVA O O U-A C.For freezer systems,is the gauge near the compressor reading the OVA B.Testing �/����.y� The following tests are to be performed at the noted interval.Report any failures on Part ill of this form same as the gauge near the dry-pipe valve? Over OfJo �J A 1.Quarterly Tests 2.Monthly Inspection hems(ki addition to above hems) A.Mechanical water flow alarm devices passed tests by opening the A Control valves with locks or electncal supervision in correct(open or inspectors test connection or bypass connection with alarms actuating closed)position? *Yes /V OVA and flow observed? Oyes ON' @,/A B.Sprinkler wrench with spare sprinklers? *Yes [ talo OVA B Post indicating valves opened until spring or torsion is felt in the rod, VV C.Gauges on wet-pipe system in good condition and showing normal ()Nov then closed back one-quarter turn'? Oven (11Vo @4/A water supply pressure? O 0/A C Main drain test for stem downstream of backflow or V V *Yes V y pressure reducing valve D.Alarm Valves. 1.Record Static Pressure 40 psi and Residual 35 psi ❑ Pressure Gauges show normal supply water pressure,free born physical See com ents-on page 2 danoge.valves in correct(open or closed)position and no leakage from retarding clamber or drains? Oyes ONo O,, 2.Was flow observed? ()Yes b ()e/u \J""' OVA V V 3.Quarterly Inspection Items(in addition to above items) 3.Are resuts comparable to previous test? Wes f'V b OVA 2.Semiannual Test(in addition to previous items) IBJ `f A.Pressure Redwing Valve.In open position,not leaking, maintaining A.Valve supervisory switches indicate movement? Oyes l�fvn ( downstream pressure per design criteria.and in good condition with /�+� B.Electrical water flow alarm devices passed tests by opening the v �- 1/A hand wheel not broken'? ()Yes ONo @4 A inspector's test connection or bypass connection with alarms actuating /��� B.I-ydraufic nameplate(calculated systems)securely attached to riser and flow observed? ®Yes ONo a aaA and legible? ()Yes Qdo OVA 3.Annual Test(in addition to previous hems) V im.// C.Fire Department Connection: V ��,,JJ�� AMain drain test: 1.Record Static Pressurepsi and Residual psi Visible.accessible,coupings and swivel not damaged and rotate 40 Pressure 35 smoothly,plugs or caps in place and undamaged,gaskets in place and ❑ See comments-on page 2 In good condition,identification signs)in place,check valve is not leaking,clapper is in place and operating properly and automatic drain �" A� 1 2.Was flow observed? (1'es OW VA placeoperating properly? ()Yes E to O/A 3.Are results comparable to previous test? Yes valve in and ? v V �J ()Yes �,�" WA B.Fre all sprinklers date 1920 or later? los { �� O (If plugs or caps are not in place.inspect interior for obstructions.) * V N'A D.Alarm devices free from physical damage? ()Yes ONo OVA C.Fast response sprinklers 20 or more years old replaced or successfully `�,JJ- sample tested within last 10 years? *Yes Oto OVA Wet Pipe Report page2 D.Standard response sprinklers 50 or more years old replaced or Oven OW OVA Part III-Comments(any"No"answers,test failureorothced on emstheslyfound with thesprive ystem v must be explained here.Also,note here any products noticed on the system that have been the successfuly 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 sample tested within last 5 years? Oves ONo 'bA F.Dry-type sprinkler replaced or successfully serrate tested within last VV 10 years? @Yes ON, adA G.Specific gravity of antifreeze correct? Oven ()No A H.AU control valves operated through full range and returned to normal position? ()Yes (No OdlA I.Backflow devices passed backflow fest? @Yes ONO OsSA J.Backflow devices passed full flow test? Oyes ONO _A K.Pressure reducing valves passed partial flow test? oyes ONO OVA 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 alarm operated? Ow Oyes ()No ( xA 5.Test to be done every 5th year \�� /�' `��JJ- A Sprinklers rated above high temperature tested? Oyes { My tr♦N/A B.Gauges checked by calibrated gauge or replaced? Oyes 0\1(.: CNA �V,J C.Pressure reducing valves passed full flow test? ( ,4C Oven ON° V x A C.Maintenance ", v 1.Regular Maintenance Items A If sprinklers have been replaced,were they proper replacements? ()Yes (Nl ®l VA B.Used hose was cleaned,drained and dried before being placed back in service? Oyes O (J ON' Oni-a C.Hose exposed to hazardous materials was disposed of or decontaminated in en approved rrenner7 ()Yes a" D.Systems normally filled with fresh water were drained and refilled twice if raw --- water got into the system? oYes Ono @ WA E.deny of the following were discovered,was an obstruction investigation conducted? 0Yes ON° @ NA Exptakr reasons)end obstruction investigation finding in Part Ill 1.Defective intake screen on purrp with suction from open sources. 2.Obstructive material discharged during water flow test. 3.Foreign materials found in dry-ppe 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 sprinlders found during activation or ateration. 6.Failure to flesh yard piping or surrounding pubic mains following new installation or repairs. 7.Record of broken mains in the vicinity. 8.Abnormally frequent fahe4dpping of dry-pipe valves. Part IV - Recommendations: Not a pert of the NFPA-25 inspection, are following items may need to 9.System is returned to service after an extended period out of service(greater than one year). be reviewed by a fire protection engineer. 10.There is reason to beleve the system contains sodium silcate or its derivatives or highly Valve seal #0006637 0006638 corrosive fluxes in copper pipe systems. F.If conditions were found that required flushing,was flushing of system �/�+�.r.y conducted? oYes Ohio OVA 2.Annual Maintenance Items(in addition to previous items) A Operating stem of all OSBv valves lubricated completely closed,and re-opened? O'" C Olily° "A B.Sprinklers and spray nozzles protecting commercial cooking equipment V and ventilating systems replaced except for bulb-type which show no /� signs of grease buildup? �X)Yes 0 N @�,WA C.Does there appear to be recalled fire sprinklers it-sstalled at firs site? OYes 0. 0,,A 3.Regular Maintenance Items V A Alarm panel clean @Yes ONO NIA B.System left in service? ()Yes ()N°()N/A C.Is system impaired?(Impairment program put into place per WPA-25 and Fortitude Fire Protection protocols) oYes ()No 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 tine was left in operational condition upon completion of this inspection except as noted in Part III above. Date: 8/4/2021 Printed Name of Inspector: Jason Kestner Signature of Inspector: c License or Certification Number(if applicable): FP I21-000 1 25 Color of tag placed on system: Red ✓Green Dellaw