Fillable Printable Underground Installation Form
Fillable Printable Underground Installation Form
Underground Installation Form
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 re presentative. 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 the 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 approving authority’s requirements or
local ordinances.
Property Name
Date
Property Address
City
State
Zip
PLANS
Accepted by approving authorities (names)
Address
Installation conforms to accepted plans Yes No
Equipment used is approved
Yes
No
If no, state deviations
INST RUCT IONS
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
If no, explain
Have copies of appropriate instructions and care and maintenace
charts been left on premises?
Yes
No
If no, explain
LOCAT ION
Supplies buildings
UNDERGROUND
PIPES AND
JOINT S
Pipe types and class
Type joints
Pipe conforms to _________________ Standard
Yes
No
Fittings conform to _________________ Standard
Yes
No
If no, explain
Joints needed anchorage clamped, strapped or blocked in
Yes
No
accordance with _________________ standard
If no, explain
T EST
DESCRIPT ION
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 (1476 L/min) for 4-inch pipe, 880 GPM (3331 L/min) for 6-inch pipe, 1560 GPM (5905 L/min) for 8-inch pipe,
2440 GPM (9235 L/min) for 10-inch pipe, and 3520 GPM (13323 L/min) for 12-inch pipe. When supply cannot produce stipulated flow rates, obtain
maximum available.
HYDROST AT IC: Hydrostatic tests shall be made at not less than 200 psi (13.8 bars) for two hours or 50 psi (3.4 bars) above static pressure In excess of
150 psi (10.3 bars) for two hours.
LEAKAGE: New pipe laid with rubber gasketed joints shall, if the workmanship is satisfactory, have little or no leakage at the joints. The amount of leakage
at the joints shall not exceed 2 quarts per hour (1.89 L/hr) per 100 joints irrespective of pipe diameter. The leakage shall be distributed over all joints. If
such leakage occurs at a few joints, the installation shall be considered unsatisfactory and necessary repairs made. The amount of allowable leakage
specified above can be increased by 1 fl oz per inch valve diameter per hour (30 mL/25 mm/hr) for each metal seated valve isolating the test section. If dry
barrel hydrants are tested with the main valve open so the hydrants are under pressure, an additional 5 oz per minute (150 mL/min) leakage is permitted for
hydrant.
FLUSHING
T EST S
New underground piping flushed according to
_________________ standard by (company)
Yes
No
If no, explain
How flushing flow was obtained
Public water
Tank or reservoir
Fire pump
Through what type of opening
Hydrant butt
Open pipe
Lead-ins flushed according to _______________ standard by (company) Yes No
If no, explain
How flushing flow was obtained
Public water
Tank or reservoir
Fire pump
Through what type of opening
Y connection to flange spigot
Open pipe
SF042 Rev. 07/09 Contractor’s M aterial and T est Certificate for Underground Piping Page 1 of 2
HYDROST AT IC
T EST
All new underground piping hydrostatically tested at
psi for hours
Joints covered
Yes
No
LEAKAGE
T EST
Total amount of leakage measured
gallons hours
Allowable leakage
gallons hours
HYDRANT S
Number installed
Type and make
All operate satisfactorily
Yes
No
CONT ROL
VALVES
Water control valves left wide open Yes No
If no, state reason
Hose threads of fire department connections and hydrants interchangeable with those of
the fire department answering alarm Yes No
REMARKS
Date left in service ________________________________ ________________________________________________________________ ________
________________________________________________________________________________________________ ________________________
________________________________________________________________________________________________ ________________________
Signature
Name of installing contractor
C of R No. SCR-
Contractor’s Address
City
State
Zip
Tests witnessed by
For property owner (signed) Title Date
For Installing contractor (signed) Title Date
Additional explanation and notes
RME
I certify that the information herein is true and that this portion of the sprinkler system was installed in
accordance with Chapter 6003, Texas Insurance Code and the rules and standards adopted by the State Fire
Marshal’s Office.
Responsible Managing Employee (signature)
CERT IFICAT ION
Responsible Managing Employee (print or type name)
RME License Number
Date
DIST RIBUT ION: Original COPY 1 Posted at site or give to owner COPY 2 for the installing firm in file accessible to SFMO
COPY 3 for local approving authority within 10 days after completion
SF042 Rev. 07/09 Contractor’s M aterial and T est Certificate for Underground Piping Page 2 of 2
