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rw�,oe,w� s�Mac�ER � Contractor's Material and Test Certificate for Under round Pi in �"��ON�°"� � g P g A.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 finally leave the job.A certificate shall be filled out and signed by both representatives.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 failwe to comply with approving authority's requirements or local ordinances.All"No"answers shall be explained in the Comments portion of this forcn. G. Flushing Tests Property Name: ��bos- �PxcxY�ct- Taa ls 1.New underground pipuig flushed according Property Address: S�}'3� (�' r ra 11 't�\o� to �`� a� standard? �Yes ❑No Date: a.Flushing conducted by(company): �x�e-¢1Cvs,,1 �-'��G B.Plans b.Flushing flow obtained from: 1 Accepted by approving authorities(names): ��blic water ❑Tank or reservoir ��e pump c.Type of opening: ❑Hydrant butt C(Open pipe Ci�r o� �„�h��•=-h�}� 3.Lead-ins flushed according to ��C'n 62� standard? ❑Yes ❑No 2.Address: 3 Installation conforms to accepted plans �'es ❑No a.Lead-ins flushed by(company): 3e�GCa.� `��Ce' 4 Equipment used is approved C✓1 Yes ❑No b.How flushing flow for lead-ins was obtauied: C. Instructions ❑Public water ❑Tank or reservoir ❑Fire pump 1.Has person in charge of fire equipment been c.Type of opening: ❑}'.connection to flange&spigot instructed as to location of control valves and / C�Open pipe care and maintenance of this new equipment C�Yes ❑No K Hydrostatic Test 2.Have copies of appropriate instructions andf�'e 1.All new underground piping hydrostatically tested at and maintenance charts been left on premises�Yes ❑No 'Z�l7 psi for 2 hours D. Location 2.All joints covered? r9'Yes ❑No , System supplies buildings: L Leakage Test E.Underground Pipes and Joints 1 Total amount of leakage measured gal hours l.Pipe types and class: G�'(DD '�R-1L1 ��VC� 2.Allowable leakage gal hours 2. Jomt type(s): YYl S J.Hydrants / 1.Number installed� ,type and make� 3 Pipe confonns to1��F�� bt�l standard�Yes ❑No 2.All operate satisfa orily? {�Yes ❑No � K Control Valves � 4.Fittings confonn to�� a�( standard0 Yes O No 1.Water control valves left wide open? C�Yes ❑No 5 Jomts needing anchorage clamped,strapped or 2.Hose threads of fire departrnent connections � � and hydrants interchangeable with those of / blocked in accordance with�as�andard Cb Yes ❑No fire department answering alann7 �Yes ❑No F.Test Description L Commetets(I'his section is for additiona!explanation and Flushing: Flow the required rate until water is clear as notes. A!! "No"answers n:ust be explained{rere.)` indicated by no collection of foreign material in bwlap bags at outlets such as h drants and blow-of�s. Flush at flows not less Y than 390 gpm for 4-inch pipe,880 gpm for 6-inch pipe, 1560 gpm for 8-inch p�pe,2440 gpm for 10 inch pipe,and 3520 gpm � for 12-inch pipe.When supply cannot produce stipulated flow � rates,obtain maximum available. Hydrostatic: Hycirostatic tests shall be made at not less � than 200 psi for two hours or 50 psi above static pressure in ` excess of 150 psi for two hours. ` Leakage. New pipe laid with rubber gasketed joints shall,if the workmanship is satisfactory,have l�ttle or no leakage at the jomts. The amount of leakage at the joints shall not exceed 2 qts per hr per 100 joints irrespective of pipe Date left in serv�ce: diameter.The leakage shall be distributed over all joints.If ❑Check here if comments continue on other side of this forn► such leakage occurs at a few joints the mstallation shall be M. Signatures considered unsatisfactory and necessary repairs made. The 1.Name of Installmg Contractor:��ez� �ir� ��.:1-ipr amount of allowable leakage specified above can be 2.Tests witnessed by increased by 1 t]oz per inch valve diameter per hr for each Property Owner(signed): metal seated valve isolatmg the test section.If dry barrel Title: Date: hydrants are tested with the main valve open,so the hydrants are under pressure,an additional 5 oz per minute leakage is I�istalling Contractor(signed): pecmitted for each hydrant. Title: Date: 02007 National Fire Sprinkler Association,40 Jon Barrett Road Patterson,NY 12563(845)878-4200 Fonn 13-U Page 1 of 1