Draper City Fire Department - Fire Prevention Division

Contractor’s Material and Test Certificate for Underground 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 leave the job.

This certificate shall be filled out and signed as indicated. 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 the approving authority’s requirements or local ordinances.

Property Name and Address:

Email- Certificate details will be emailed to this address

Plans

Accepted by approving authorities (names): DRAPER CITY FIRE DEPARTMENT

Address: 1020 East Pioneer Road Draper, Utah 84020

Installation conforms to accepted plans

Yes

No

Equipment used is approved

Yes

No

Instructions

Has person in charge of fire equipment been instructed as to location of control valves and care and maintenance of this new equipment?

Yes

No

Have copies of appropriate instructions and care and maintenance charts been left on premises?

Yes

No

Location

Supplies Buildings

Underground Pipes and Joints

Pipe types and class

Type Joint

Pipe conforms to __________ standard

Yes

No

Please type the standard that the pipe conforms to

Fitting conforms to __________ standard

Yes

No

Please type the standard that the fitting conforms to

Joints needed anchorage clamped, strapped, or blocked in accordance with NFPA standards.

Yes

No

Test Description

Flushing: Flow the required rate until water is clear as indicated by no collection of foreign material in burlap bags at outlets such as hydrants and blow-offs. Flush at flows not less than 390 gpm for 4-in. pipe, 880 gpm for 6-in. pipe, 1560 gpm for 8-in. pipe, 2440 gpm for 10-in pipe, and 3520 gpm for 12-in. pipe. When supply cannot produce stipulated flow rates, obtain maximum available.

Hydrostatic: Hydrostatic tests shall be made at not less than 200 psi for 2 hours or 50 psi above static pressure in excess of 150 psi for 2 hours.

Hydrostatic Testing Allowance: Where additional water is added to the system to maintain the test pressures, the amount of water shall be measured and shall not exceed the limits of the following equation.

Image of test description formula

L= testing allowance (makeup water), in gallons per hour
S= length of pipe tested, in feet
D = nominal diameter of pipe, in inches
P = average test pressure during the hydrostatic test, in psi gauge.

Underground Pipes and Joints

New underground piping flushed according to__________ standard by (company)

Yes

No

Please type the standard being used

How flushing flow was obtained

Public water

Tank or reservoir

Fire pump

Through what type opening

Hydrant butt

Open pipe

Lead-ins flushed according to standard by __________ (company)

Yes

No

Company completing the lead-ins flush

How flushing flow was obtained

Public water

Tank or reservoir

Fire pump

Through what type opening

Y connection to flange & spigot

Open pipe

Hydrostatic Test

All new underground piping hydrostatically tested at _______ psi

For ______ hours

Joints Covered

Yes

No

Leakage Tests

Total amount of leakage measured_______ gallons

______ hours

Allowable leakage _______ gallons

______ hours

Hydrants

Number Installed

Type and make

All operate satisfactorily

Yes

No

Control Valves

Water control valves left wide open

Yes

No

Hose threads of fire department connection and hydrants interchangeable with those of fire department answering alarm.

Yes

No

Remarks

Date left in service

Signatures

Name of sprinkler contractor?

Tests witnessed by

For property owner (signed)

Title

Date

For installing contractor (signed)

Title

Date

Additional explanation and notes