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SPRINKLER FIRE PROTECTTVE SERVICE
350 Mlin Street .W. Yrrmouth, MA 02673.(5OE) 775-2400
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lli.kfl o* Prevenlion Delices
Name of Premise
Fax(508) 778-9628
Tel # 508-398-6889
Address
Owner
Address
REPORT #
REPORT DATE
Owner's Section
/5 ' ?.{Barbara Roa uth Yarmouth, MA 02664
St. Pius X Tel # 508-398-6889
/.,?1Barbara Road-South Yarmouth, MA 02664
F 17372 ANNUAL TEST & INSPECTION
2.26-c1 SEMI-QRTLY INSPECTION
X
A. Explain any occupancy hazard changes since the previous inspection
None
B. Describe ,ire protection modifications since the last inspection
None
C. Describe any fires since the lasl inspeclion
None
D. When was the system piping last checked for stoppage, corrosion, or foreign matter?
February 3,2000
E. When was the dry piping system lasit checked for proper pitch?
February 3,2000
F. Are dry valves adequately protected from freezing?
Yes
1.) General
A. ls the building occupied?
B. Are all systems in service?
C. ls there a minimum of 18 in. clearance
between the top of the storage and the sprinkler
deflector?
D. ln areas protected by wet systems, does all
of the building appear to be properly heated?
E. Does the hand hose on the sprinkler system
ap ear to b
G. 2" main drain flowed?
H. Dry system, low points drained this
inspection?
l. Alarms tested this inspection?
lnspection comments:
x
x
_-__ll_
x
x
x
SPRINKLER SYSTEM REPORT OF TEST & INSPECTION
St. Pius X - Life Center
F. ls the
YES NO N/A
x
YES NO N/A
2.) Control Valves
A. Are all sprinkler system control valves and all
other valves in the appropriate open or closed
position?
B. Are all control vales in the open position and
locked, sealed, or equipped with a tamper
switch?
x
x
x
3.) Water Supplies
A. Was a water flow test of the main drain made
at the sprinkler riser?
4.1 Tanks. Pumps. Fire Department Connections
A. Are fire pumps, gravity tanks, reservoirs, and
pressure tanks in good condition and properly
ma intained?
B. Are fire department connections in
satisfactory condition, couplings free, caps in
place, and check valves tight? Are they
accessible and visible?
5.) Wet Svstems
A. Are cold weather valves (O.S. & Y.) in the
appropriate open or closed position?
B. Have antifreeze system solutions been
tested?
C. Were the antifreeze test results satisfactory?
x
x
x
x
x
x
x
x
5.) Drv Svstems
A. ls the dry valve in service?
B. Are the air pressure and priming water level
in accordance with manufacturer's instructions?
C. Has the operation of the air or nitrogen
supply been tested?
D. Were low points drained during this
inspection?
E. Did quick opening devices operate
satisfactorily?
F. Did the dry valve trip properly during the trip
pressure test?
G. Did the heating equipment in the dry-pipe
valve room operate at the time of inspection?
x
x
x
7 ) Soecial Svstems
-A
Did the deluge or preaction valves operate
properly during the last test?
B. Did the heat-responsive devices operate
properly during testing?
C. Did the supervisory devices operate during
testing?
8.) Alarms
A. Did the water motor and gong test
satisfactorilY?
B. Did electric alarm test satisfactorily?
C. Did supervisory alarm service test
satisfactorilY?
9.) Sprinklers' R*re all sprinklers free from corrosion,
loading, or obstruction to spray discharge?
B. Are sprinklers less than 50 years?
C. ls stock of spare sprinklers available?
D. Does the exterior condition of the sprinkler
system appear to be satisfactorily?
E. Are sprinklers of proper temperature ratings
for their locations?
10.) Date dry-pipe valve tested (control valve partially open)
'l 1.) Date dry-pipe valve tested (control valve fully open)
12. ) Date quick-opening device tested
13.) Date deluge or preaction valve tested
'14.) Review control valve maintenance
YES NO N/A
2-3-00
N/A
N/A
N/A
N/A
x
x
x
x
x
x
x
x
x
x
DRY PIPE
OPERATING
TEST
DELUGE
A PRE.
ACTION
VALVES
N
Trip Test Table
DRY VALVE
Control Valve Maintenance Table
o.o.o.
IF NO. EXPLATN
SERIAL NO
NO
OPERATEO
PROPERLY
HYORAULIC
NO
NO
N/A
MAXIMUM TIME
TO OPERATE
RELEASE
Control Valves Number Type Open Secured Closed
sEc
ExPlain
Abnormal
Signs Condition
SERIAL NO.MAKE MODELMAKEMOOEL
DRELIABLE
TIME
WATER
REACHEO
TEST
OUILET
WATER
PRESSURE
AIR
PRESSURE
TRIP POINT
AIR
PRESSURE
TIME TO TRIP
THRU TEST
CONNECTION
PSr MIN SEC YESSECPStPStMIN
x3914N/A2165
wlTHOUT
Q.O.D.
wlTX
Q.O.O
PNEUMATIC ELECTRICOPERATION
YESYESNODETECTING MEDIA SUPERVISEOPIPING SUPERVISEO
YESDOES VALVE OPERATE FROM THE MANUAL TRIP ANO/OR REMOIE CONTROL
STATtOt{S
IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING
DOES EACH CIRCUIT OPERATE
SUPERVISION LOSS ALARM
DOES EACH
CIRCUIT OPERATE
VALVE RELEASE
MAKE
NOYES
MOOEL
YES NO YES NO MIN
II II
City Connection
PIV NONE
Tank Control
Valves NONE
Pump Control
Valves NONE
Sectional
Control Valves NONE
System Control
Valves 2 OS&Y YES YES NO YES NONE
Other Control
Valves NONE
Make Model Type Serial #
FEBCO 805 DC 89281
Location
lnspectors Test
Valve
Auxiliary Drain
Valves
1
NONE
BACK LEFT OF LARGE HALL
--_T--
Size
Backflow Valve 4"
Size
15 ) Water Flow Test at Sprinkler Riser
Water supply source City? X Tank?Pump? _
Date Size
Test Pipe
Static
Pressure
65
Residual
Pressure
60Last Flow Test 2-3-00 RISER z',
Current Flow Test 2-26-01 RISER 2',63 60
16.) Heat Responsive Devices
Test Method NONE
Type of Equip
Manufacturer
Test Results:
Valve No.
Valve No.
Valve No.
Valve No.
ment
ABCDEFABCDEFA B C DE FA B C DE F ABCDEFABCOEFA B C DE FA B C DE F
Valve
Valve
Valve
Valve
No.
No.
No.
No.
Auxiliary Equipment: No? X Type? _ Location?
-
Test Result?
-17. ) Explain any "No" answers and comments
18. ) Adjustments or conections made during this inspection.
NONE
19.) Although these comments are not the result of an engineering review, the
following desirable improvements are recommended.
NONE
lnspectods Name
Company
Date
ROBERT BRODIE
A & B CANCO
FEBRUARY 26,2OO1
Test Pipe
Location
1F-