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RIMAYEC� ENing Corp. 2 8 2024 ID PO Box 9, Hawthorne,NY 10532 Phone(914)579-0015 VILLAGE OF RYE BROOK Email: Rotundopc@gmail.com BUILDING DEPARTMENT Westchester County Lic.#916 Putnam County Lic.#2984 Village of Rye Brook Building Department 938 King Street Rye Brook, NY 10573 TRANSMITTAL Date: 05/22/2024 Re: Sprinkler and or Standpipe Reports-King Street Rehab Copies of Reports attached for your files. Thank you. Respectfully, Ashiey Votta-Olive tnsNction Tesi .,r; 0I1d llt;orintuion Maintenance trance of Fir s Form covers the ntirlirt;tlrni re e Sprtnklet S ste /=olt;ectedlodisfributions qulremenlsul'7\,')' � � � y n7S Nnrrowur,nt:s°NW"1en maNtiain fire yslelns wilh,:,:,, ; P 5-199_ Assocternnlnr pumps and,eater(anl;s ,, ('pPlelnenlat tanks of lile um for fire sprinkler systems water spray fixed s p Ps• Separate forms arc nvailttblc to inspect,less antl l,uonal forms are also available for depending on the co n(diiionstd Foarn-,va: oft, e occ, sprmnd%systems•More frequent ;Ilspc,i'Pc ode se s tenis.pnnee ma Owner: NQ y� n`-Y, ir,d water sup Private fire service rn,lini `� ��' ll'1/�I�J �a y be nceessar). f7IvnCr's Address: -- Proper))•being Inspected— Pruperly Address: k Date of Inspection: this inspection is(check q Daily NuIC: y �' '•r('=kIY o Monthly uarterl All questions arc to be ans.vcrcd Yes,r•, ;• •1 Y 0 Semi All of r\pplieable. Annual D Annual o Third year r]f iftll Y punscs refer to the current ins .. . All"No•'answers arc to be cz I '•'I ,crforn,ed car rt I - p\vner's '—I on the date shown above. Plaincd in lht commClits portion oi'this Irvin. Section (r c ;r•••:,t, �/�) ered by the Owner or A. Is the building occupied? 1'cs Occupant.) 13. Has the OCCupancy classification a,0 cI N/A �'• Are all fire protection systems in se, ..;;rd Of rttenls remained the same since the last inspection? D. 1-Ins(he system remained in service ,; zS O N I- W o ❑ N/A Was the system free ofacluations of n,t Ittodiftcalion since(Ile last inspection? No `�N r\ >. • -s or alarms since the la cs o No o Nir\ I at t II - Inspector's Scc(ion Iasi inspection'? , N,o A. Inspections N/A (•pnily.or tveel(ly if lo,v temperature fnclasures armutd dry ,i e ins(allcd 2. W4eeld ! pe or deluc,• naintainin,, InspeCilOil Itents ! .minimum uf.lO. 1:0 � r\. I'rcaruun turd l)Clu,. O Yes O Nu �N-A 1.I•iVe li•uni Ill yWal cl`unaic ?. Print vnh'cs in a J 1'c. R• Dn'•PiP�V,11,•,:,; Itprnpn:ne taper "No P"vi r.:1 I. Free tiara ;h)'i J.No Icakage Irum valve seat? d)pusiliult? ,�• Yes _�(� I s, tt Jamage:' :r Y'c<'I.Electrical corn O Yc c,i�p r J/A No T.,iA 2.Trio,,-ah •' ::N,, e-!poncn(s in service? ill appropriate., a No tyWIA (open or cluze(j)pusiliun q Yes C. itclicfpori on recluc I 3• No leakage from O'1 O11) ec pressure ba, g' om intermeclintc chamber? 3•\Vechly inspcctivn it• in'o„Cnl10n assemblies0�� A GaugescI"s ,which ctrn br ........ „ not continuous) � on dry,prencli,,;, :c monthly it the i )'dlschargln b Yes 0 No 9 N/ U No ,/A and delui:' ins it ten'a r,rt direct A H• Conlrol Valv I good condition an Y�uPc'vrscd nr secured with ll,ka cs: d showing normal air and,v I.In normal(upon ur closed alCr pressure? posili O Yes U NO A 2.5CalCd locked o' a;,,:,•va`d•? �. e` O NO 0 N/A ]NI. J.Accessible? U N/A ••NOrJ IV.' . •I,NoviQc(I with al,pfo lariat': wr nr' 3.free I-rOm eslermil Ic,i;s? G YCs O No '�"r'r\ G.1'ravitled will)a,; o iderllir .� t'. Isolalion valves n',; _ Ycs 0 NO,o t r;..,m�. O N;A J,Monlbl• prcvtnr• Inspoct(on Item!: �rnhlics in Open position:' A.proper nurnher and r.• �!YCS n NO O N/A .pc ail Sparc spri• }•CS I)•Sprinkle'wrench,with.I;,,rt•sprinkle• I•, 0 NO o N/A 1,-Gauges on%wi ' `� n NO o N;,\ plpc Kurd C 0.Alai11 dcvieei free Gr,:,, ,and shoWinY nunnal,calCr su I, , E.Alarm V I"•sieal darn ,rr: "If eleeir•ieal ettnnceliOns 5eftpr;. pre-surf:,IlvCs: �YCS fu No r.N/.A I.Free indicsuin,:n•,• ' " 'C, 0 No r I 2.free Irunt hsi,•:4.I:: , / ::sort? p�\/es r]No O N!•A .1.Vuly ' n NrA CS In apprupri:nr�„,.4.No Icakngcli•orn rr:ta,.. , cl,ur clr: - 'iiion? ��•I'•Sprinkler Prc chaml' ! $YesONO °"iA MAY 2 8 2024 ssurC (.:Onlrn: Cs c No O W.I•In open position? (, oNo ' ' GE OF RYE BROOK2.Nol l eakin Uoa ING DEPARTMENT ].Maimaining ODorn•t,.,.. .prc.isurc :, Nod c L•• r!n criteria? o Ycs 4,In 6 00(NIIOnvhcCi. O No 1992 National fire S rinklr, :',: - 0 Yes p NO >�A p ,lion. P•r I" (I Pancrsun,NY 125G3 S„m 1 or J.°nnied T192 4..Monthly Inspection Items(Conti ,t G.Fife Department Connections I.Visible and accessible?. ( Y•, r)No ID N/A 2.Couplings and swivels not dn, . DYcs O N J.Plugs or caps in place and un ':d R'td rot cc smoothly? O O N/A 4.Gaskets in place and in goo,l `o , Xes O No O N/A 5.ldentiftcalion sign(s) in P.-• Yes C)NO O N/A 6.Check vaJvc iJ not Ica};i g' "I ,r.'' O No O NIA 7•Automatic rz di: CJ NO O N/A rn v slur to Plnr :a o criun (Nose: lfplugs or err;js arc nor i :•r•:er i,rs B Properly? O Yes O No ❑N/A obstructions oa,i ver, Char the : pcct the interiorfor !�' c clepper is operational over its full range.) S.Quarterly Inspect:on Item HydraUlic namc;)late,if provi,?•• 'eor(il attached to riser and legible? O yes O No O N/A 4•Annual inspectlon A.Visible sprinH,- t; 1.Free of corn';iUn? (21 I O N/A 9. Visible pipe: 2.Free of ,'•strtrctio„s to , --// I• In good condition? 2T Yes O No O NIA =rns. Yes O No O N/A 2. Free of rneehani al damage. 3.Fret of'r,rci)- m�CM /Y,• O No O N/A ? Q Ycs O No U NIA 4.Free of i+tint? f3 Ycs r /A 3. Not 1ealCing') Yes O N O N/A 5. Free of;+hysical darn �''�. d. No external corrosto ?—Yes O No O N/A O No O NIA S. Properly aligned? �cs O No ❑NIA C.Visible pipe i. ,• r' ind sei::; • not damaged or loose? 6. No extemal loads? Ycs O No O N/A D.Adequate hcrt , ,;I,hlc to arc g O Ycs O_NN O N/A `,crc `r'•i sprinkler piping is located? fd Yes O No O N/A (Must be done before cold weather,) S.Annual,or every;iltll year for vii •tti;n can be reset without opening: Interior ofdry,-1,i• p,,.,cdo„ ;,,,• ,,e +•;:lves passed internal inspccdon? O Yes O No eIN/A 6.Fifth Year Inspecti, I ttins A.Alarm valves '!•••.ir,cso,;;. •••lin is. filters and restriction orifices passed internal inspection? eyes/ B.Check valves. • -Ily inspec- ;J ::li harts operate properly,move freely and are in good condition? eyes O NoO/NIA C.Strainers,fill.,. „•trd orii.3.Testing I>hragm chambers on dry-pipe. preaction and deluge valves Passed internal inspection? ' O Yes O No-CrN/A The following tests are to be. ,•ford al h• in ,I.Quarterly Tests .•als. Report any failures on Pan III of this form. A.Sprinkler sysr• in rlr:,in t 1.Recor :r:ssur• $7 ;;i ,;, ! Residual Pressure 2,me r=:.• rot i_ Psi- Was flow observed? O Yes O No O NIA :'•+ure morn lost test? Q'Yes O No O N/A 13.Walerflow aln• ict p ::.• 1.Inspect. r "%vet.pipe when not in freezingweather 2.Bypass n••;don o • , t r .••: )I yas O No O N/A J.Alarms o •Inc systems in freezing weather,dry pipe.preaction•or deluge). I! Yes O No O NIA �' �' '/A Was now observed? O Yes O No O N/A C.Control vnlv,;+ .,t qs•.. , _.zr.:parnred ind'catins buttcrtly valves)opened until spring or torsion is felt in the rod•then closed h, arter i•:. O No t�N/A D.Priming warn •� �cd r. D.lowing pre,,, ; ;i� d,., I and preaction systems? O Yes O No EI N/A :reaction Systems passed test? O Yes O No 211/A 2.Semiannual Test Quick opening.d• issad ; �. r)No O N/A 3.Annual Tests N/A.Are all sprits;; vice B.Fast Rcspons YJ Ycs ONO O N/A 's in i:,tcr. than 20 years? O Yes O N CJ N/A C.Standard spri. rvic• ff"no"lest sample now and every/0 years. E cez 0 years. O)'as O No t N/A [f"no•'rest sample now and every 10 years• D.Specific rav :'.,s O No N/A S.All control v,:' r:r,•tl t „ .; !gc and resumed to normal position? O Yes O No O NIA F.Preaetion a„d al.ec st:(except deluge valves where water can't be discharged) (Be sure to ic.rr ns nr „,hich are designed to opera a simultaneously in care ojfira.) I.Water::' fro.,+, impeded? O Yes O 2.Press,+• at t. t�/A st remote nozzle ^ psi, 3.Resirh,• ten 4,Are al--. Psi. was now observr d? O Yes O No t-N/A '5 c' A-coign values? O Yes No rISN/A• 5,Maro r•' ,-de, -,;? O Yes O No O N1A 6.Autun: Jr;r .;sw _ r devices passed test? O Yes O No eNIA 01992 National Fire Sprini< i r00,Patterson,NY 12563 Sheet 2 of 3,Printed 7/92 3.Annual Tcs(,,(C,. (j) G.Dry-pipe ,,al :Iiaj now I. "eco"i ial air pros 2. Record sir W water p 3. P;n8 Ili psi. 4. 131C.Co:.1 Ming Lillie psi. S.Arc:1 :suits corn H.Autorrillir .;. " teriancc di 'Ous tests? Q Yes 0 No 0-01A )'-P1pc and prcacli n systems passed test? I J. Sackno- oasscd bar Yes 3 No 7�4 C) yes ET No' N/A Passed Ful: K All sprinkler� jr-c rcg ! Yes Z)tqOz1141A Dry-pipe full test to be '-'-lives Passed full no%k,test,) C:)Yes L-) NO'!!T'NIA A.Drv-pipe k,.11. now trip .1'third year. ajr press- R,.c,f, I water pr lig air pre /si St. liverccl (C. and Lnpping time I---- IcSl connection? C)ye—x/AC, Ate::ou tilts con, s C)N S.Tests to be "ious tests? 0 Ye A.ExLra Hiph. V, ri 1) year. r. s 0 No -Ira High -9)Temperature sprinklers test ? (3 D.Gauges cj.�:..;, ins( calibr 'CP12ccd? 0 Yes 0 No 0 N/A Yes 0 No ES N/A C. Maintenance ills A.If sprin):!..,_.. n repllc( B.Air leaks 7 PfOper replacements? 0 yes'M system r 0 No d*NIA C.01T.Pipc S': I,-n "'Surc,loss More than 10 Psilweek repaired? 0 yes 0 No D.Wcrc niaint, IdItion 0</A .Inv'M -ing dis, It 5�10 Yes 0 No EMIA I.D' ves Q% 0 NIA If yes.c011dicf on obstri,ction 2.01-..(r, e screen ring Suction from Open S in vestigOtion andflus),Mt S%.Flc,n. Itcrial dis -og waterflow tests. sources. 3.F%r,�!. ,I 4 1 Is found fl%'cs.check valves or pumps. • anon or S.Pi "rainkiers r in test 01 Plugg'ng Or illsPcetors test connection. 6.Piuj,, riga6on or alteration. . in Pip".7. ,, ,luring alterations. to yard pit $.R,,r j 0 ".-ding public mains following new Installation or repairs. 1 mains 9.Ahr -inr -.1tiem fat .. lry-pipe valves. ]led to s Io heiie extended period out Of service(greater than one ye Allnua 0laim'. 'Ontains sodium silicate or its derivatives. ar). A Operall,lit !. B.interior o,*,. -PI .:.I C I io I I c0r`PIGIcIY closed and rcOPc <11 N/A C Lou points ...,in Q Yes 0 No JeN !s cleaned? 0 yes 0 No ","cA 95N D.5prinkici, Jsl 'Jelugc systems prior to the onset or freezing weather? 0 Yes Q No C`N`/� wh;0. lcs pr �-rciaj cooki Or No N/A 93�1,`Pmcnl ❑and ventilating SYS(cms rcplaccd r Z_N/A -xccpl for bulb.type Pill-' tTi commew -------- Of other problems found with the sPrim'der syslern must be explained herc.1 ---—------ PRrt IV - InspeCior'S Illf,,), !"IUMbing Corp. ....... Inspector: :11y: 1:1% Company's Address: NY 10532 cc UW(lit ial'orinat: 1015 !S fe n Pon "A Plilcl:of my inspection,and .,,on except as noted in P a that all equipment tcsicd ail ITT at is time ire of inspector about. this rric (01992 National Fire Sprinkler Assv':i'llion, ll.i Sheet 3 or 3.Printed 7M ��qlmndoM�CIEE ��� ing core. PO Box 9,Hawthorne,NY 10532 MAR - 2022 Phone(914)579-0015 VILLAGE OF RYE BROOK Email: Rotundopc@gmail.com Westchester County Lic.#916 Putnam County Lic.#2984 BUILDING DEPARTMENT Village of Rye Brook Building Department 938 King Street Rye Brook, NY 10573 TRANSMITTAL Date: 03/01/2022 Re: Backflow Reports Copies of Reports attached for your files. Thank you Respectfully, Dariana Wagman form for Inspection, Testing and Maintenance of Fire S rinkler Systems ystems NAilonAt FIRE SPRINKLER ASSOCIATION.INC Itllorination on this form covers the minimum requirements of NFPA 25-1992 for fire sprinkler systems connected to distribution systems without supplemental tanks of fire pumps. Separate forms are available to inspect,test and maintain fire pumps and water tanks, Additional forms are also available for standpipe and hose systems,private fire service mains water spray fixed systems and foam-water sprinkler systems. More frequent inspection,testing,and maintenance may be necessary depending on the conditions of the occupancy and water supply. Owner: h �� Owner's Address: 7'57 ��'r� 51' I-7ooIC Property being Inspected: Property Address: Date of Inspection: ,oc-0 This inspection is(check one): o Daily 0 Weekly o Monthly a<uarterly ❑SemiAnnual o Annual o Third year o Fifth Year Note. All questions are to be answered Yes,No or Not Applicable. All"No"answers arc to be explained in the comments portion of This thine. All responses referocurrent inspection performed on the date shown above. Part I -Owner's Section (To be answered by the Owner or Occupant,) A. Is the building occupied? lYKes o No o N/A B. Has the occupancy classification and hazard 0 ontents remained the saute since tine last inspection? ids I-- ,No o N A C. Are all fire protection systems in service? ce Yes o No o N/A D. Has the system remained in service without modification since the last inspection? e-y—es o No o NiA E. Was the system free of actuations of devices or alarms since the last inspection? 45'Y-es o No o N/A Part II - Inspector's Section A. Inspections 1.Daily,or weekly if low temperature alarms are installed fncletsures around dry-pipe or deluge valves maintaining n minimum of 40' F'? o Ye. o Nu 2. Weekly Inspection Items NiA A. Preaction and L)eltlge Valve: I. Free trim physical damn e! R. Dr)-Pipe Valves: ?. Krim valves in appropriate(open g J Yes ^No Z<A I. Free front physical damage' :t Yes 3.No leakage from valve seat? o Yesinappropriate'. .: v'u ✓!�`\ es closed)position'? 0 yes c No 2r'NiA 2. Trim vatic in appropriate:' o No �1/A 4. L-;lecirical components in service? o Yes o No ef9)/A (open or closed)position 0 Yes u No kt-fgi.A 3.No leakage from intermediate chamber? o Yes C. Relief port on reduced pressure backflow prevention assemblies not continuously dischargin o Yes a KO 0 N/A o No 01q/A 3.Weckly inspcction items which can be performed monthly if the items are directly supervised or secured with locks A. Gauges on dry,preaction and deluge systems in good condition and showing normal air and water pressure? o Yes n No o N/A B. Control Valves: I. In normal(open or closed)position? 0,-yes o No o N/A 2.Sealed locked nr supervised? ar'Yes o No o N/A 3.Accessible? t'!Ycs o No o N/A 4.Provided with appropriate wee chess'? o Yes o No e'&iA 5.Free from external leaks? eyes ❑No o N/A 6.Provided with appropriate identification? tTlyes o No o Ni.A C. Isolation valves on backflow prevention assemblies in open position'? . 4.Monthly Inspection items �s o No o N/A A.Proper number and type of spare sprinklers? &<s o No o N/A 13.Sprinkler wrench with spare sprinklers'? ire. o No o NIA C'.Gauges on wet-pipe system in good condition and showing normal water supply U' pressure! des U No f'.N/A D.Alarm devices free from physical damage and all electrical connections secure? tehe o No 0 N'/A .Alarm Valves: I.Gauges indicating normal supply water pressure;' vlres o No 0 N'A 2.Free front physical damage? I�es o No o N/A 3. Valves in appropriate(open or closed)position? taxes o No o NIA 4.No leakage from retarding chamber or alarm drains? ff Yes o No o N/A F.Sprinkler Pressure Regulating Control Valves. I. In open position? o Yes o No e'l/A 2.Not Leaking? Cl Yes In No p1f�/A 3.Maintailning downstream pressure per design criteria? o Yes ❑No 17 1V/A a.In good condition with handwheels not broken? 0 Yes o No dFl/A 1992 National Fire Sprinkler Assocation,P.O. Box 1000,Patterson,NY 12563 Sheet 1 of 3.Printed 7192 4.Monthly Inspection Items(Continued) G.Fire Department Connections I.Visible and accessible? m Yes O No O N/A 2.Couplings and swivels not damaged and rotate smoothly? ff"�es O No O N/A 3.Plugs or caps in place and undamaged? 0"Yes ❑No O N/A 4•Gaskets in place and in good co 'on? m Yes O No O N/A 5.Identification sign(s)in place? Yes O No O N/A 6.Check valve is not leaking? Yes O No O N/A 7. Automatic drain valve in place and operating properly? 3`'es O No O N/A (Note: 1f plugs or caps are not in place, inspect the interior for obstructions and verify that the valve clapper is operational over its full range.) S.Quarterly Inspection Item Hydraulic nameplate,if provided,securely attached to riser and legible? O Yes O No O N/A 4.Annual Inspection Items A.Visible sprinklers: B. Visible pipe: 1.Free of corrosion? 1.1 Yes O No O N/A 1.in good condition? 0'4es O No O N/A 2. Free of obstructions to spray�p sterns? 0'4es O No O N/A 2. Free of mechanical damage? @'Yes O No O N/A 3.Free of foreign materials? Id Yes O No O N/A 3. Not leaking? des O No O N/A 4.Free of paint? QlrYes O No O N/A 4. No extemal corrosion? O"Yes O No O N/A 5.Free of physical damage? Wfes O No O N/A 5. Properly aligned? dYes O No O N/A 6. No external loads? fa'Yes O No O N/A C.Visible pipe hangers and seismic braces not damaged or loose? ff"Y es O No ❑N/A D.Adequate heat available to areas where wet sprinkler piping is located? 21yes O No O N/A(Must be done before cold weather.) 5.Annual,or every fifth year for valves which can be reset without opening: Interior of dry-pipe,preaction and deluge valves passed internal inspection? O Yes O No 0'N/A 6. Fifth Year Inspection Items A.Alarm valves and their associated strainers,filters and restriction orifices passed internal inspection? ZTes O No O N/A B.Check valves internally inspected and all parts operate properly,move freely and are in good condition? er"Yes O No O N/A C.Strainers,filters,restricted orifices and diaphragm chambers on dry-pipe, preaction and deluge valves passed internal inspection? B.Testing O Yes O No a'l'/A The following tests are to be performed at the noted intervals. Report any failures on Part III of this form. 1.Quarterly Tests A.Sprinkler system main drain to t 1.Record Static Pressure psi and Residual Pre5surc6Q psi. Was flow observed? .d-Yes O No O N/A 2.Are results comparable to pressures from last teat? O'Yes O No O N/A B.Waterflow alarm devices passed tests? I.Inspectors test connection opened?(wet-pipe when not to freezing weather) 1-11*y-es O No O N/A 2.Bypass connection opened?(wet-pipe systems in freezing weather,dry-pipe,preaction,or deluge). eYes O No O N/A 3.Alarms actuated? Wes O No O N/A Was now observed? eYes O No ❑N/A C.Control Valves(except OS&Y and gear-operated indicating butterfly valves)opened until spring or torsion is felt in the rod,then closed back one-quarter turn? O Yes O No eN/A D.Priming water level passed test in dry-pipe and preaction systems? O Yes O No L'TN/A E.Low air pressure signal in dry-pipe and preaction systems passed test? O Yes O No 1N/A 2.Semiannual Test Quick opening.devices passed test? O1"Yes O No O N/A 3.Annual Tests A.Are all sprinklers in service dated 1920 or later? eyes O No O N/A B.Fast Response sprinklers in service for less than 20 years? O Yes O No &N/A /f"no"test sample now and every 10 years. C.Standard sprinklers in service for less than 50 years? EfYes O No O N/A 1f"no"test sample now and every 10 years. D.Specific gravity of antifreeze correct? O Yes O No JIN/A E.All control valves operated through full range and returned to normal position?ZYes O No O N/A F.Preaction and deluge valves full flow trip test:(except deluge valves where water can't be discharged) (Be sure to test all systems at the same time which are designed to operate simultaneously in case of fire.) 1.Water discharge from all nozzles unimpeded? O Yes O No erN/A 2.Pressure reading at hydraulically most remote nozzle - psi. 3.Residual pressure reading at valve __ psi. Was flow observed? O Yes O No 1:1 N/A 4.Are above readings comparable to design values? O Yes O No ESN/A 5.Manual activation devices passed test? O Yes O No 1/A 6.Automatic air pressure maintenance devices passed test? O Yes O No ef-N/A 01992 National Fire Sprinkler Association,P.O.Box 1000,Patterson,NY 12563 Sheet 2 of 3.Printed 7/92 3.Annual Tests(continued) G.Dry-pipe valve partial flow trip test: I. Record initial air pressure psi. 2. Record initial water pressure psi. 3. Record tripping air pressu / psi, 4.Record tripping time (see.). 5. Are above results comparable to previous tests:' O Yes O No fa'N/A H.Automatic air maintenance devices on dry-pipe and preaction systems passed test? O Yes O No ZN/A I Backflow devices passed backflow test? O Yes O No ia?V/A J. Backflow devices passed full now test° O Yes J No 2!'N/.q K All sprinkler pressure regulating control valves passed full flow test') O Yes O No O N/A 4. Dry-pipe full flow trip test to be done every third year. A. Dry-pipe valve full flow trip test: 1. Record initial air pressure psi. 2Record initial water pressure psi. Record tripping air pressure psi and tripping time 4 Was water delivered to inspectors test connection' 0 Yes O No 2-N/A 5 Are above results comparable to previous tests? O Yes 0 No OT4/A S.Tests to be done every fifth year. A.Extra High.Very Extra High and Ultra High Temperature sprinklers tested? 0 Yes O No ITN/A B.Gauges checked against calibrated gauge or replaced? O Yes O No 2rN/A C. Maintenance 1. Regular Maintenance Items A.If sprinklers have been replaced, were they proper replacements? 0 Yes 0 No �N A B.Air leaks in dry-pipe system resulting in pressure loss more than 10 psi/week repaired? O Yes 0 No EM/A C.Dry-pipe systems being maintained in dry condition? 0 Yes O No CarVA D.Were any of the following discovered? 0 Yes ZNo 0 NIA If yes.conduct on obstruction investigation and flush tile.ststem. I. Defective intake screen for pumps taking suction from open sources. 2 Obstructive material discharged during waterflow tests. 3.Foreign materials found in dry-pipe valves.check valves or pumps. 4. Heavy discoloration of water during drain test or plugging of inspectors test connection. 5. Plugging of sprinklers found during activation or alteration. 6.Plugging found in piping dismantled during alterations. 1.Failure to flush yard piping or surrounding public mains following new Installation or repaus. 8 Record of broken mains in the vicinity. 9 Abnormally frequent false-tnpping of dry-pipe valves. 10.System is returned to service after an extended period out of service(greater than one year). I I There is reason to believe the system contains sodium silicate or its derivatives. 2.Annual Maintenance Items A Operating stem of all OS&Y valves lubricated,completely closed,and reopened? O Yes O No W'N/A B. Interior of dry-pipe,preaction and deluge valves cleaned? 0 Yes 0 No Grf(/A C Low points drained in dry-pipe, preaction and deluge systems prior to the onset of freezing weather? O Yes O No Q'N/A D.Sprinklers and spray nozzles protecting commercial cooking a9,uipment and ventilating systems replaced except for bulb-type which show no signs of grease buildup? 0 Yes 0 No t]'�1/A Part III - Comments (Any "No" answers,test failures or other problems found with the sprinkler systero must be explained here.) Part IV - Inspector's Information Rotundo Plumbing Corp. Po Box 9 Inspector: Corn ar)y: Hawthorne, NY 10532 - --- ..— . ....._.. P Company's address: 914-579-0015 1;ccn�titf5ATt i tfnhe nation on rrect at the time and ptac6 of my inspection,and that all equipment tested at this time er real con to n of this inspection except as noted in Pan [11 above. — Siguature of Inspector 01992 National Fire Sprinkler Association, P.O. Box 1000,Patterson,NY 12563 Sheet 3 of 3,Printed 7/92 Rgtundo D CEC IEWE �� uing Corp. PO Box 9,Hawthorne,NY 10532 MAY 2 3 2022 ID Phone(914)579-0015 Email: Rotundopc@gmail.com VILLAGE OF RYE BROOK Westchester County Lic.#916 Putnam County Lic.#2984 BUILDING DEPARTMENT Village of Rye Brook Building Department 938 King Street Rye Brook; NY 10573 TRANSMITTAL Date: 05/20/2022 Re: Backflow Reports Copies of Reports attached for your files. Thank you Respectfully, Dariana Wagman NEW YORK STATE DEPARTMENT OF HEALTH BureauEmpire St PubltePl8WaterSupply ingTorot Roo Report on Test and Maintenance Empire Stale Pla=a_Coming Tower Room 1110 Albany,NY 12237 of Backflow Prevention Device Please use a separate form for each device. For the yeard test- Comp/ete entire form Kra ROTUNDO PLUMBING CORP 95 MARSH HILL ROAD PUTNAM VALLEY EdpAnnul'Ial test Complete Part Aonly Public Water Supply Account No. County WESTCHESTER Block Lot Facility Name���tG, S u(s L Location of Device.,Q � t'4� L > >-1•n / (S nn o� by r ..�' Address � S f t Q rC�U LL 10 J7 Street C ty Zip Device Manufacturer Type RPZ Model Information Size inches) Serial Number 7S 3V /l o ' ' Check Valve No.1 Check Valve No.2 Differential Pressure Relief Line Pressure L' psi Valve Test Leaked Date Leaked O ened at before Closed ti ht p psid repair g Closed tight P sure drop across first check valve psid M D Y Describe repairs and Repaired by materials Name used Lic# Date repaired: m F—P m M D Y Final test Closed tight D Closed tight ❑ Opened at Date P psid F FT-1Pressure drop across firstM D Y check valve psid Wator r u er Met—Roadin 9 T o of arvlee::(chock one) t 7 V,� omestic Fire E]Other Remarks(Desuibe deficiencies:bypasses,outlets before the device,connections between the device and point of entry,missing or inadequate airgaps,etc.) Certification:This device meets' does NOT meet,the requirements of an acceptable cant inmen evice at the time of testing he certify t foregoii g data to be correct. Print Name Certified Tester No. Si atu Expiration Date Property owners(orowners ag nt)certification that test was performed: Pint Name Title at a Telephone Certification that installation is in accordance with the approved plans. (To be completed by the design engineer or architact or water supplier.) I hereby certify that this installation is in accordance with the approved plans. Name Title Date rDOH Log# License Number Phone( ) d m y Representing Describe minor installation changes Address City State Zip Signature NO I E:bona ona comp Bled copy to the designated hea lh department representative and one copy Io the water suppler within 30 days o the testing device. Notify owner and water supplier immediately i/device fails test and repairs cannot immediately be made. r DOH- 1013(9/91) FILRttindo �, ing Corp. MAY 19 2022 PO Box 9,Hawthorne,NY 10532 Phone(914)579-0015 VILLAGE OF RYE BROOK Email: Rotundopc@gmail.com BUILDIrJG DEPARTMENT Westchester County Uc.#916 Putnam County Uc.#2984 Village of Rye Brook Building Department 938 King Street Rye Brook, NY 10573 TRANSMITTAL Date: 05/10/2022 Re: Sprinkler and or Standpipe Reports-King Street Rehab Copies of Reports attached for your files. Thank you Respectfully, Dariana Wagman Gorm for Inspection, Testing and Maintenance of Fire Sprinkler Systems NATIONAL FIRE 5FRWKIER AssooArioN nc Inf'ornation on this form covers the minimum requirements of NI'PA 25-1992 for fire sprinkler systems connected to distribution systems without supplemental tanks of fire pumps. Separate fomis are available to inspect,test and maintain fire pumps and water tanks. Additional forms arc also available for standpipe and hose systems,private fire service mains water spray fixed systems and foam-water sprinkler systems.More frequent inspection,testing,and maintenance may be necessary depending on the conditions of the occu y 1and water supply. OwnerI,1°, 1Zy and Owner's Address �$' Kt ng �� � i �� Property being Inspected: Property Address: Date of Inspection: •��`• This inspection is(check one): O Daily O Weekly o Monthly uarterly ❑SemiAnnual ❑Annual o Third year O Fifth Year Noic. All questions are to be answered Yes,No or Not Applicable. All"No"answers arc to be explained In the comments portion orthis limn. All responses refer to the current inspection performed on the dale shown above. Part I - Owner's Section (To be answered by the Owner or Occupant.) A. Is the building occupied? td'1'cs o No O N/A B. Has the occupancy classification and hazard off ntents remained the same since the last inspection? -eV—est.-No 1 N A C. Are all fire protection systems in service? re'4es o No o N/A D. Has the system remained in service without modification since the last inspection? des O No o NiA E. Was the system free of actuations of devices or alarms since the last inspection? o"re—s 0 No o N/A Part II -Inspector's Section A. Inspections I.Daily,or weekly if low temperature alarms arc installed Foclosures around dry-pipe or deluge valves maintaining;I minimum of 40• P, o Yes n No efl�A 2.Weekly Inspection Items A. Preaction and Deluge Valves: I.Free lium physiril damn e? R. Dn-Pipe Valve>: n @ -3 Yes No -�N.:1 I. Free from physical Krim valves in appropriate(open or closed)Poi ion'' 3 Yes C:NO �iA 2 Prim v Jam:Igedamage*., :t Y'r> vatic in appropriate'' 3.No leakage from valve seat? o Yes o No 5N/A 4. L•'lecirical components in service? o Yes c No e1/A (open or closed)Position o Yes o No e'rVi.A 3. No leakage from intermediate chamber? o Yes C. Relief pon on reduced pressure backflow prevention assemblies not continuously dischargin O Yes .moo o N/A c No ,e'N/A 3.weekly inspection items which can be performed monthly it the Items are directly supervised or secured with locks A. Gauges on dry,preaction and deluge systems in good condition and showing normal air and ,eater pressure? O Yes O No n NiA f3. Control Valves: , I.In normal(open or closed)position? Yes rYN'o o N/A 2.Scaled locked o//r supervised'? �es o No ❑N/A 3.Accessible., XfYi's o No o N/A 4.Provided with appropriate wrenches? o Yes o No ,dv \ 5.Free from external leaks? ties o No o N/ 6.Provided with appropriate identification? p yles o No ❑!-;A C. Notation valves on baekflow prevention assemblies in open Position? W< a. Monthly Inspection Items s ❑No ❑N/A A.Proper number and rope of spare sprinklers? 17//. o No o NIA 13.Sprinkler wrench will,spare sprinklers'?Iyes o No o NIA C.Gauges on wet-pipe s)stenl in good condition and showing nurnlal cater supPl! prey�U"ure' _J Tyes ri No n N/A D.Alarm devices free from physical damage and all electrical connecliuns secure?,t�Ye, o No c NIA E.Alarm Valves: I.Gauges indicating normal supPh ,eater pressure'? W<1 p No z N'A 2. Free from physical damage? /'Yes 0 No o NiA 3. Valves in appropriate(open or eloxd)position? ellyes r-No o NIA 4.No leakage from retarding chamber or alarm drains'?{Yes c No o N/A I'.Sprinkler Pressure Regulating Control Valves. I.In open position? o Yes O No WN/A 2.Not Leaking? ❑Yes ❑No rsfV/A 3.Maintaining downstream pressure per design criteria? o Yes o NoNIA 4.in good condition with handwheels not broken? o Yes o No • /A 1992 National Fire Sprinkler Assocaiion,P.O. Box Io00. Panersun,NY 12563 Sneer t or 3.Vnnjoa 7192 4,Monthly Inspection Items(Continued) G.Fire Department Connections:// I.Visible and accessible? of Yes ❑No O N/A � 2.Couplings and swivels not damaged and rotate smoothly? IO Yes O No O N/A 3.Plugs or caps in place and undamaged? O Y�5 O No O N/A 4.Gaskets in place and in good cond. ion? C'jYes O No O NIA 5.Identification sign(s)in place? Yes O No O N/A 6.Check valve is not leaking? Q1 Yes O No O N/A 7. Automatic drain valve in place and operating properly? eyles O No O N/A (Note: If plugs or caps are not in place,inspect the interior for obstructions and verify that the valve clapper is operational over its full range.) S.Quarterly Inspection Item Hydraulic nameplate,if provided,securely attached to riser and legible? 0 Yes O No CYIV/A 4.Annual Inspection Items A.Visible sprinklers: B.Visible pipe: 1.Free of corrosion? 0"Ycs O No 0 N/A 2.Free of obstructions to s ra attetns. I• In good condition? Cl Ycs O No O N/A P y patterns? B'S'es O No O N/A 2. Free of mechanical damage? 21fes O No O NIA 3.Free of foreign ma erials? eyes 0 No O N/A 3. Not leaking? J'f-Yes ONO O N/A 4.Free of paint? Yes O No O N/A a. No external corrosion? aYes O No 0 N/A 5.Free of physical damage? Qf"Yes O No O N/A 5. Properly aligned? Yes O No O N/A C.Visible pipe hangers and seismic braces not damaged or loose? b.No external loads? B'S'es D No O N/A g O'Yes O No O N/A D.Adequate heat available to areas where wet sprinkler piping is located? Ulf es 0 No O N/A(Must be done before cold weather.) 5.Annual,or every fifth year for valves which can be reset without opening: Interior of dry-pipe,preaction and deluge valves passed internal inspection? 0 Yes ❑No O NN/A 6.Fifth Year Inspection Items A.Alarm valves and their associated strainers,filters and restriction orifices passed internal inspection? 0"Yes ❑No O N/A B.Check valves internally inspected and all parts operate properly,move freely and arc in good condition? O'Ycs O No O N/A C.Strainers,filters,restricted orifices and diaphragm chambers on dry-pipe, preaction and deluge valves passed internal inspection? B.Testing O Yes 0 No CWJA The following tests are to be performed at the noted intervals. Report any failures on Part III of this form. 1.Quarterly Tests A.Sprinkler system main drain to 1. Record Static Pressure psi and Residual Pressure psi. Was flow observed? rl Yes O No O N/A 2.Are results comparable to pressures from last test? eyes O No O N/A B. Waterflow alarm devices passed tests? I.Inspectors test connection opened?(wet-pipe when not to freezing weather) ales O No 0 N/A � 2.Bypass connection�o�pined?(wet-pipe systems in freezing -rather,dry-pipe,preaction,or deluge). Cl Yes O No O N/A 3.Alarms actuated? 0 Yes 0 No O N/A Was now observed? O"Yes 0 No 0 N/A C.Control Valves(except OS&Y and gear-operated indyi sting butterfly valves)opened until spring or torsion is felt to the rod,then closed back one-quarter turn? O Yes O No I /A D.Priming water level passed test in dry-pipe and preaction systems? O Yes 0 No 0'F4/A E.Low air pressure signal in dry-pipe and preaction systems passed test? 0 Yes 0 No JZM/A 2.Semiannual Test Quick opening.devices passed test? eyes 0 No 0 N/A 3.Annual Tests A.Are all sprinklers in service dated 1920 or later? doy es O No O N/A B.Fast Response sprinklers in service for less than 20 years? 0 Yes O No WK/A If"no"test sample now and every 10 years. C.Standard sprinklers in service for less than 50 years? eYes O No O N/A If"no•'test sample now and every 10 years. D.Specific gravity of antifreeze correct? 0 Yes 0 No 0M/A E.All control valves operated through full range and returned to normal position? eyes O No O NIA F.Preaction and deluge valves full flow trip test:(except deluge valves where water can't be discharged) (Be sure to test all systems at the some time which are designed to oper to simultaneously in case of fire.) I.Water discharge from all nozzles unimpeded? O Yes O NN N/A 2.Pressure reading at hydraulically most remote nozzle 3.Residual pressure reading at valve , psi. Was flow obsee ed? O Ycs O No �/A 4.Are above readings comparable to design values? O Yes O No N/A 5.Manual activation devices passed test? O Yes O No 0 /A 6.Automatic air pressure maintenance devices passed test? O Yes 0 No a IV/A 01992 National Fire Sprinkler Association, P.O.Box 1000,Patterson,NY 12563 Sheet 2 of 3.Printed 7/92 ` 3.Annual Tests(continued) G.Dry-pipe valve partial flow trip test: I.Record initial air pressure psi. 2.Record initial water pressure psi. 3.Record tripping air pressur psl. 4.Record tripping time (sec.). 5. Are above results comparable to previous tests? O Yes O No 05 —/ H.Automatic air maintenance devices on dry-pipe and preach n systems passed test? O Yes O No t�N/A I Backflow devices passed backtlow test? 0 Yes O No /A I Backflow devices passed full flow test? O Yes 0 No X-v/,q K All sprinkler pressure regulating control valves passed full flow test,) O yes 0 No O'N/A 4.Dry-pipe full now trip test to be done every third year. A.Dry-pipe valve full flow trip test: 1. Record initial air pressure psi. Record initial water pressure s, t Record tripping air pressure psi and tripping time_ a Was water delivered to inspectors test connection? O Yes O No ZrN/A 5 Are above results comparable to previous tests? O Yes O No (aN/A S.Tests to be done every fifth year. A.Extra High, Very Extra High and Ultra High Temperature sprinklers tested? 0 Yes 0 No 0'N/A B Gauges checked against calibrated gauge or replaced? O Yes O No 2r`N/A C. Maintenance 1.Regular Maintenance Items A.If sprinklers have been replaced,were they proper replacements? O Yes Q No 3<1/A B.Air leaks in dry-pipe System resulting in pressure loss more than 10 psi/week repaired? O Yes O No 2rN/A C.Dry-pipe systems being maintained in dry condition? O Yes O No oaN/A D Were any of the following discovered? O Yes @'110 0 NIA if yes, Conduct an obstruction investigation and flush the sisrem I Defective intake screen for pumps taking suction from open sources. 2 Obstructive material discharged during water-now tests. 3. Foreign materials found in dry-pipe valves.check valves or pumps. 4 Iteavy discoloration of water during drain test or plugging of inspectors test connection. 5 Plugging of sprinklers found during activation or alteration. 6.Plugging found in piping dismantled during alterations 7.Failure to flush yard piping or surrounding public mains following new Installation or repays. 8 Record of broken mains in the vicinity. 9 .Abnormally frequent false-tripping of dry•pipc valves. 10 System is returned to service after an extended period out of service(greater than one year). I I There is reason to believe the system contains sodium silicate or its derivatives 2.Annual Maintenance Items _/ A operating stern of all os&1' valves lubncated,completely closed,and reopy 'd? O Yes 0 No R! N/A B.Interior of dry-pipe, preaction and deluge valves cleaned? 0 Yes 0 No PI N/A C Low points drained in dry-pipe,preaction and deluge systems prior to the onset of freezing weather? O Yes 0 No 8M/A D Sprinklers and spray nozzles protecting commercial cooking auipmeni and ventilating systems replaced except for bulb-type which show no signs of grease buildup? O Yes O No d-N/A Part III - Comments (Any "No" answers,test failures or other problems fou:d with the sprinkler system must be explained here.) Part IV - Inspector's Information Rotundo Plumbing Corp. _ Po Box 9 Inspector: Company. Hawthorne, NY 10532 Company's address: 914-579-0015 1 certify ie information on l2 f rm r t at the time and placb of my inspection,and that all equipment tested at this time wat lef" do condition n comp a on of this inspection except as noted in Part Iff above. — Siguaturc of lospecior Ul 92 National Fire Sprinkler Association, P.O. [lox 1000,Patterson,NY 12563 Sheet 3 of 3,Printed 7/92 Roun d o oD ECE � PO Box 9,Hawthorne,NY 10532 AUG 18 2022 Phone(914)579-0015 Email: Rotundopc@gmail.com VILLAGE OF RYE BROOK Westchester County Lic.#916 Putnam County Lic.#2984 BUILDING DEPARTMENT Village of Rye Brook Building Department 938 King Street Rye Brook, NY 10573 TRANSMITTAL Date: 08/12/2022 Re: Sprinkler and or Standpipe Reports-King Street Rehab Copies of Reports attached for your files. Thank you Respectfully. Dariana Wagman form for Inspection, Testing and Maintenance of Fire Sprinkler Systems NATIONAL FIRE SPRINKLER ASSOCIATION.INC Intormation on this form covers the minimum requirements ofN17PA 25-1992 for fire sprinkler systems connected to distribution systems without supplemental tanks of fire pumps. Separate forms are available to inspect,test and maintain fire pumps and water tanks. Additional forms are also available for standpipe and hose systems,private fire service mains water spray fixed systems and foam-water sprinkler systems. More frequent inspection,testing, and maintenance may be necessary depending on the conditions of the occupancy and water supply. Owner: Owner's Address- Property being Inspected: Property Address: _ Date of Inspection: This inspection is(check one): ❑ Daily o Weekly a Monthly a Quarterly ❑SerniAnnual annual o Third year r Fifth Year Note All questions are to be answered Yes.No or Not Applicable. All"No"answers arc to he explained in the comments portion of this form. All responses refer to the current inspection performed on the date shown above. Part I- Owner's Section (To be answered by the Owner or Occupant.) ra<S A. Is the building occupied? ❑No c N/A B. Has the occupancy classification and hazard 91,11"ontents remained the same since the last inspection? -41es t:No C.N A C. Are all fire protection systems in service? wfYes o No o N/A D. Has the system remained in service without modification since the lase inspection? fe< ❑No o NiA E. Was the system, free of actuations of devices or alarms since the last inspection? zhes a No o N/A Part II - Inspector's Section A. Inspections 1.Daily,or weekly if tow temperature alarms are installed Enclosures around drn-pipe or deluge salves maintaining a minimum of•IW F? owes ❑Nu W11 A 2.Weekly Inspection Items A. ('reaction and Deluge Valves: R Dr -Pipe Valves: I.Fret lrum physical damage'? As c No a,<A I. I-rce tram ph%sicat damage" tier 2. 1'rim valves in appropriate(open or closed)position? m Yes Z No Ni.A 2.Trim%al%e in appropriate" 3.No leakage from valve seat? o Yes ❑No wNIA (open or closed)position c Yes o Nu r.Nt.A 4.E'lectrical components in service? o Yes o No arN/A 3.No leakage from intumicdiate chamber? ❑Yes C. Relief port on reduced pressure backflow prevention assemblies not continuously dischargin o Yes o No o N/A o No 2-N/A 3.Weckly inspcctiotr items which can be performed monthly if the items are directly supervised or secured with locks A. Gauges on dry,preaction and deluge systems in good condition and showing normal air and water pressure'? o Yes o No xt-le/A B. Control Valves: 1.In normal(open or closed)position'? dyes o No o N/A 2.Scaled locked or supervised'? aa�'es o No o N/A 3.Accessible? tr�Ycs o No o N/A 4. Provided with appropriate wrenches? o Yes ❑No 0*"NiA 5.Free rrom external leaks? ^, es o No ❑NIA 6.Provided with appropriate identification? tales o No o N!A � C. Isolation valves on backflow prevention assemblies in open position? yt'Yes o No o N/A 4.Monthly Inspection Items A.Proper number and type of spare sprinklers? er'T'es o No o N/A 11.Sprinkler wrench with spare sprinklers'. V Yee o No a NIA C.Gauges on wet-pipe system in good condition and showing twrmal hater supply pressure? ❑'4es ❑No r,N/A D.Alarm devices free from physical damage and all electrical connections seeure7 keYes o No o N/A E..Alarm Valves: I.Gauges indicating normal supply water pressure? r Y'cc o No o N!A 2.Fret;from physical damage? lQes a No r3 NIA 3 Valves it)appropriate(open or closed)position'? tl''es ::No ❑NIA 4.No leakage from retarding chamber or alarm drains? coles c No C N/A F.Sprinkler Pressure Regulating Control Valves. I. In open position? o Yes o No cv*A 2.Not Leaking? ❑Yes o No 014/A 3. Maintaining downstream pressure per design criteria? o Yes o No ta'N/A 4.In good condition with handwheels not broken? o Yes ❑No 005I/A 1992 National Fire Sprinkler Assocalion, P.Q Box 1000.Patterson,NY 12563 Sheet I of 3 vrrnled 7192 4.Monthly Inspection Items(Continued) G.Fire Department Connections:/ I.Visible and accessible? �Yes 0 No 0 N/A _/ 2.Couplings and swivels not damaged and to tc smoothly? Z Yes 0 No 0 NIA 3.Plugs or caps in place and undamaged? Oyes 0 No O N/A 4.Gaskets in place and in good condition? Q1'Yes O No O N/A S.Identification sign(s)in place? zrYes O No 0 N/A 6.Check valve is not leaking? dyes O No O N/A 7. Automatic drain valve in place and operating properly? O Yes O No O N/A (Note: If plugs or caps are not in place, inspect the interior for obstructions and verify that the valve clapper is operational over its full range.) 5.Quarterly Inspection Item / Hydraulic nameplate,if provided,securely attached to riser and legible? li3 Yes 0 No O N/A 4.Annual Inspection Items A.Visible sprinklers: B.Visible pipe: 1.Free of corrosion? 0 Yes 0 No O N/A� 1.In good condition? eyes O No O NIA 2.Free of obstructions to spray atterns? let Yes O No O N/A 2. Free of mechanical damage? Zyes O No O N/A 3.Free of foreign materials?PYes 0 No O N/A 3. Not leaking? O Yes U No U NIA 4.Free of paint? 'Yes O No O N/A 4. No external corrosion? OrYes O No O N/A 5.Free of physical damage? KYes 0 No O NIA 5. Properly aligned?6 Yes 0 No 0 N/A 6. No external loads? frYes O No 0 N/A C.Visible pipe hangers and seismic braces not damaged or loose? Oly-les 0 No 0 N/A D.Adequate heat available to areas where wet sprinkler piping is located? lrYes 0 No O N/A(Must be done before cold weather.) S.Annual,or every fifth year for valves which can be reset without opening: Interior of dry-pipe,preaction and deluge valves passed internal inspection? 0 Yes ❑No ONN/A 6.Fifth Year Inspection Items A. Alarm valves and their associated strainers,filters and restriction orifices passed internal inspection? 0`Yes 0 No 0 N/A B.Check valves internally inspected and all parts operate properly,move freely and are in good condition? TYes O No O N/A C.Strainers,filters,restricted orifices and diaphragm chambers on dry-pipe, preaction and deluge valves passed internal inspection? O Yes 0 No 0TN/A B.Testing The following tests are to be performed at the noted intervals. Report any failures on Part III of this form. I.Quarterly Tests A.Sprinkler system main drain te� 1.Record Static Pressure psi and Residual Pressure 60- psi. Was flow observed? Wly'es O No 0 N/A 2.Arc results comparable to pressures from last test? 0"Ves 0 No O N/A B. Waterflow alarm devices passed tests? �/ 1.Inspectors test connection opened?(wet-pipe when not to freezing weather) t Yes 0 No Q NIA 2. Bypass connection opened?(wet-pipe systems in freezing weather,dry-pipe,preaction,or deluge). r 'es 0 No 0 N/A 3.Alarms actuated? eyes 0 No O N/A Was Flow observed? ( Yes 0 No O N/A C.Control Valves(except OS&Y and gear-operated indicating butterfly valves)opened until spring or torsion is felt to the rod,then closed back one-quarter turn? 0 Yes O No 0IN/A D.Priming water level passed test in dry-pipe and preaction systerns? O Yes O No,0'N/A E.Low air pressure signal in dry-pipe and preaction systems passed test? O Yes O No,.nN/A 2.Semiannual Test Quick opening.devices passed test? 2'1es O No 0 N/A 3.Annual Tests !! A.Are all sprinklers in service dated 1920 or later? Q'Ye O No O N/A B.Fast Response sprinklers in service for less than 20 years? 0 Yes O No O'K1/A /f"no"rest sample now and every 10 years. C.Standard sprinklers in service for less than 50 years? �ef"Yes O No 0 N/A If"no"test sample now and every 10 years. D.Specific gravity of antifreeze correct? O Yes 0 No O N/A E.All control valves operated through full range and returned to norma'I position? 7rYes 0 No 0 N/A F.Preaction and deluge valves full flow trip test:(except deluge valves where water can't be discharged) (Be sure to lest all systems at the same time which are designed to operate simultaneously in case of fire.) I.Water discharge from all nozzles unimpeded? 0 Yes O No Cj'N/A 2.Pressure reading at hydraulically most remote nozzle psi. 3.Residual pressure reading at valve psi. Was flow observed? O Ycs 0 No Er</A 4,Arc above readings comparable to design values? O Yes O No 011NIA 5,Manual activation devices passed test? O Yes 0 No ESN/A 6.Automatic air pressure maintenance devices passed test? O Yes 0 NO.rN/A 01992 National Fire Sprinkler Association,P.O.Box 100fl,Patterson,NY 12563 Sheet 2 of 3,Printed 7/92 3.Annual Tests(continued) Co.Dry-pipe valve partial flow trip test; 1.Record initial air pressure p 1. 2. Record initial water pressure psi. 3.Record tripping air pressur psi. 4. Record tripping ume (sec.) 5.Are above results comparable to previous tests:' O Yes O No Z N/A � H. Automatic air maintenance devices on dry-pipe and preact systems passed test? O Yes O No f IA I Backflow devices passed backflow test) O Yes J No A'J ti'/A J Backnow devices passed full nownowtest:' J Yes `7 No TN/ / K All spnnklcr pressure regulating control valves passed full flow test' O Yes O No 2 [�/A 4.Dry-pipe full flow trip test to be done every third year. A.Dry-pipe valve full flow trip test. I.Record initial air pressure p '- Record initial water pressure psi 3 Record tripping au pressure _ psi and tnpping rime ( c.). a Was water delivered to inspectors test connection) O Yes O No N/A 5 Are above results comparable to previous tests? O Yes O No N/A 5.Tests to be done every fifth year. A.Extra High,Very Extra High and Ultra High Temperature sprinklers tested? O Yes O No O N/A B.Gauges checked against calibrated gauge or replaced') O Yes O No O N/A C. Maintenance 1. Regular Maintenance Items A.If sprinklers have been replaced, were they proper replacements? O Yes O No 2t N/A B.Air leaks in dry-pipe system resulting in pressure loss more than 10 psi/ eek repaired? O Yes O No 6 N/A C. Dry-pipe systems being maintained in dry conditi O Yes O No 2rNiA D Were any of the following discovered? O Yes 14 No O N/A If yes, conduct an obstruction investigation andJfush the s%stern. I Defective intake screen for pumps taking suction from open sources. 2 Obstructive material discharged during waterflow tests. 3. Foreign materials found in dry-pipe valves,check valves or pumps 4. Heavy discoloration of water during drain test of plugging of inspectors test connection. 5 Plugging of sprinklers found during activation or alteration. 6 Plugging found in piping dismantled during alterations. 7. Failure to flush yard piping or surrounding public mains following new installation or repairs. 8 Record of broken mains in the vicinity. 9 Abnormally frequent false-tripping of dry-pipe valves. 10 System is returned to service after an extended penod out of service(greater than one year). I I There is reason to believe the system contains sodium silicate or its denvatives. 2.Annual Maintenance Iterns A Operating stem of all OS&Y valves lubricated,completely closed,and reopened.? t] Yes O No N/A B. Inienor of dry-pipe,preaction and deluge valves cleaned:' O Yes O No 2'9/A C Low points drained in dry-pipe,preaction and deluge systems prior to the onset of freezing weather? O Yes O No QUA D Spnnk crs and spray nozzles protecting commercial cooking�iptncnt and ventilating systems replaced except for bulb-type which show no signs of grease buildup? O Yes O No N/A Part III - Comments (Any "No" answers, test failures or other problems found with the sprinkler system must be explained here.) Part IV - Inspector's Information Rotundo Plumbing Corp. 95 Marsh Hill Road Inspector. Company. Putnam Valley, NY 10579 Company's Address: Phone (914)579-0015 1 certify at ilizatafe orrect at the time and placb of my inspection, and that all equipment tested of this time a ions co non n c pletion of this inspection except as noted in Part III above. Signature of lnspector 01992 National Fire Sprinkler Association,P.O. Box 1000, Patterson,NY 12563 Sheet 3 of 3,Printed 7/92 ��Rtkjndo ing Corp. rflD ESc EPO Box 9, Hawthorne,NY 10532Phone(914)579-0015 JUN 3 0 1013 Email: Rotundopc@gmail.com Westchester County Lic.# 916 Putnam County Lic.#298411,.LAG : t i- RYE-BROOK F3UjL01NG DEPARTMENT Village of Rye Brook Building Department 938 King Street Rye Brook, NY 10573 TRANSMITTAL L Date: 06/27/2023 Re: Backflow Reports Copies of Reports attached for your files. Thank you Respectfully, Marie Paulino 4", e7 KU 1: Alt BY-A )A iell; t-w .70 Alt AlW 44 NiIy AW oll -A&.4 02, 44 Form f-or Inspection, Testing and Maintenance of Fire Sprinkler Systems NATIpNI1L rant SVttWKIEfl Information on this form covers the minimum requirements of NFPA 25-1992 for fire sprinkler systems ti53)CIATM WC connected re distribution safer La without supplemental tanks of fire pumps. Separate forms are available to inspect,tell artd maintain fire pumps and water tanks. Additional forms are also available for standpipe and hose systems,private fire service mains water spray fixed systems and Foam-water sprinkler systems. More frequent inspection,testing,and maintenance may be necessary depending n t e conditions of the(' /pa cy d water supply. Q,vlll'f: ' S-t' �[4- Owner's Address: 771577 71 ,n Property III, Inspected: e w� ts Property Address: Date of Inspection: lltis inspection is(check one): o Daily o Weekly G Monthly uanerly o SemiAnnual o Annual ❑Third year n Fifth Year Note All questions are to be answercd Ycs.No or Not Applicable. All"No"answers arc to be explained in the comment-,portion of this torn, All respunses refer to the current inspection performed on the date shown above. Part I-Owner's Section (To be answered by the Owner or Occupant.) A. Is the building occupied? w eS n No ::j N/A C. Has the occupancy classification and hazard o ontents remained C the same since the last inspection? r_No c N ,q C. Are all fire protection systems in service? ❑No a N/AD. Has the system remained ill service without modification since the last inspection? +des o No o NiA E. Was the system free of actuations of devices or alarms since the last inspection?O'Ves o No ❑N/A Part II-Inspector's Section A. Inspections I.Daily,or weekly if low temperature alarms are installed la,clnwres around drv-pipe or deluge sah•cs maintaining a minimum of d tt(1'f? n Yes o No 'A 2.Weekly Inspection Items Preaction and Deluge Vahes: I.Free Ilium physical damn �g') R Dr)-Pipe Valve,: Z-1 Yes z. No A I I rce IiunT physical damapc:' :I Ye, -Nr, �. 2. I rim valves in appropriate(open or closed)position? U Yes c No eK',.A 2.1 rim valtc in a \ 3.No leakage from valve seat? u Yes o No eNN/A pproprime•' 4 Electrical components in service? o Yes o No goKIA (open or closed)posinon o Yes u No TNiA 3.No leakage from intermediate chamber? o Yes C. Relief port on reduced pressure backnow prevention assemblies not continuously dischargin o Yes o No o N/A o No 1</A 3.Weekly inspection iterns which can be performed monthly irthe items sire directly,upervised or secured with locks A. Gauges on dry,preaction and deluge systems in good condition and showing normal air and water pressure? ❑Yes o No o NiA B. Control Valves: I.In normal(open or closed)position? figs a No o N/A 2.Sealed locked or supervised'? ef es o No ❑N/A 3.Accessible? t1"Yes o No n N/A 4.Provided with appropriate wrenches') ry Ye, e No elGA 3.Free from external leaks? dyes o!vo ❑MA 6.Provided with appropriate identification? ,!Yes -i No e w;A C. Isolation valves on backflow prevention assemblies in open position,, 4.Monthly Inspection Items es ONO c N/A A. Proper nurnher and type of spare sprinklers! wrTes e No o N/A B.Sprinkler wrench with spare sprinklers? I!Ycs o No e NiA C'.Gauges on wet-pipe sysicm in good condition and shot,intt normal„atcr supply pr"surc'' es o No tI N/A D.Alarm devices free from physical damage and all electrical connections secure? jiYes o No n N/A E.Alarm Villves: I.Gauges indicating normal NuppIN %%atcr pressure" tfcs a'No N•A 2. Free fi'um physical damage? efSes o No U NiA .3 Valves in appropriate(open or close(l)position? ur'Qes c No n N;A 4.No leakage Irom retarding chamber of alarm drains? cii fes U No o NIA F.Sprinkler Pressure Regulating Control Valves. I.In open position? a Yes o No t<N/A 2.Not Leaking? o Yes n No 801R1/A 3.Maintaining downstream pressure per design criteria? o Yes o No 11�/A 4.In good condition with handwheels not broken? o Yes o No ff N/A 1992 National Fire Sprinkler Assocation, P.O BOX 1000.Patterson,NY 12563 Sheet t of 3.vnnleo 7192 4,Monthly Inspection Items(Continued) G. Fire Department Connections 1.Visible and accessible? ; Yes O No ❑N/.,k � 2 Couplings and swivels not damaged and rot to smoothly? a Yes O No O N/A 3 Plugs or caps in place and undamaged? es O No O NIA 4.Gaskets in place and in good condition? Yes O No O N/A 5 Identification sign(s)in place? 2(Ycs O No Cl N/A 6.Check valve is not Leaking? O'Yes O No O N/A 7. Automatic drain valve in place and operating properly? t�cs O No O N/A (Note: If plugs or caps are not in place, inspect the interior for obstructions and verify that the valve clapper is operational over its full range.) 5.Quarterly Inspection Item Hydraulic nameplate, if provided,securely attached to riser and legible? ❑Yes O No @-N/A 4.Annual Inspection Items A.Visible sprinklers 1.Free of corrosion? B Visible pipe: Yes O No O NIA I. In good condition? fifes O No O N/A 2.Free of obstnuctions to spray a(terns? eyes O No O N/A 3.Free of foreign materials?spray O No O N/A 2 Free ea mechanical damage? Yes O No U NIA 4.Free of paint? 3. Not leaking? �'es O No O N/A p C�Yes O No O N/A 4. No extemal corrosion? 2'1'rs O No O N/A 5.Free of physical damage? ZrYes U No U N/A 5. Properly aligned? 4_Yes O No O N/A C. Visible pipe hangers and seismic braces not damaged or loose? 6.No extemal loads? Yes O No 0 N/A D.Adequate heat available to areas where wet sprinkler piping is located? 21'Yes❑0 No O N/A(Must be done before cold weather.) S. Annual,or every fifth year for valves which can be reset without operting: Interior of dry-pipe, preaction and deluge valves passed internal inspection? ❑Yes ❑No 3'N/A 6. Fifth Year Inspection Items A. Alarm valves and their associated strainers,filters and restriction orifices passed internal inspection? Or Yes O No Cl N/A B.Check valves internally inspected and all pans operate properly,move freely and are in good condition?Z-Ycs O No O N/A C.Strainers, filters,restricted orifices and diaphragm chambers on dry-pipe, preaction and deluge valves passed internal inspection? B.Testing O Yes O No ErN/A The following tests are to be performed at the noted intervals. Report any failures on Part III of this form. 1.Quarterly Tests A.Sprinkler system main drain to 1.Record Static Pressure psi and Residual Pressure psi. Was flow observed? es O No ❑N/A 2.Are results compnrnblc to pressures from Inst test? Yes ONO O N/A S. Waterflow alarm devices passed tests? 1. Inspectors test connection opened'(wet-pipe when not in freezing weather) eryes O No O N/A 2.Bypass connection opened?(wet-pipe systems in freezing weather,dry-pipe,preaction,or deluge). eyes O No O NIA 3.Alarms actuated? J21 Yes ❑No O NIA Was flow observed? CrYes O No ❑N/A C.Control Valves(except OS&Y and gear-operated indicating butterfly valves)opened until spring or torsion is felt in the rod,then closed back one-quarter tum? O Yes O No Cr`N/A / D.Priming water level passed test in dry-pipe and preaction systems? O Yes D No e N/A E.Low air pressure signal in dry-pipe and preaction systems passed test? O Yes U No Q'N/A 2.Semiannual Test Quick opening.de.vices passed test? 41-yes O No U N/A 3.Annual Tests A.Are all sprinklers in service dated 1920 or later? eyes O No ❑N/A B.Fast Response sprinklers in service for less than 20 years? O Yes O No Gr /A If"no"test sample now and every 10 years. C Standard sprinklers in service for less than 50 years? ZrYes O No O N/A If"no" rest sample now and every 10 years. D.Specific gravity of antifreeze correct? O Yes O No eN/A E.All control valves operated through full range and returned to normal position? O Yes O No 41 /A F. Preaction and deluge valves full 'low trip test:(except deluge valves where water can't be discharged) (Be sure to test all systems at the same time which are designed to operate simultaneously in case of frrv.) 1.Water discharge from all nozzles unimpededo O Yes O No RfN/A 2.Pressure reading at hydraulically most remote nozzle %psi. 3.Residual pressure reading at valve �_ psi was flow observed? O Yes O No 26UA 4.Are above readings comparable to design values? O Yes No a N/A 5,Manual activation devices passed test? O Yes ❑No4PJ NIA 6.Automatic air pressure maintenance devices passed test? O Yes O No V/A ©1992 National Fire Sprinkler Association,P.O.Box 1000,Patterson,NY 12563 Sheet 2 of 3,Printed 7/9r2 3.Annual Tests(continued) G.Dry-pipe valve parlial flow trip test: I.Record initial air pressure-__ psi_ 2 Record initial water pressure_ psi. 3 Record tripping air pressure psl. 4.Record tripping time 5. Are above results comparable to previous tests? O Yes O No �/A H Automatic air maintenance devices on dry-pipe and preaction systems passed test? O Yes O No r,?orq/A I Backflow devices passed back-low, test? O Yes O No ZN/A J Backfloty devices passed full flow,test:' O Yes J No eN/.q K All 5pnnklcr pressure regulating control valves passed full now test'' O Yes O No 2-N/A d,Dry-pipe full flow trip test to be done every third year, A. Dry-pipe valve full aow trip test I Record initial air pressure psi Record initial water pressure psi / 1 Record tripping air pressure_ psi and tripping time .t Was water delivered to inspectors test connection' ❑Yes O No , 5 Are above results comparable to previous tests? C)yes O No �h/A S.Tests to be done every fifth year. �N/A A.Extra High, Very Extra High and Ultra High Temperature sprinklers tested? O Yes O No (I'N/A B Gauges checked against calibrated gauge or replaced? O Yes O No KIN/A C. Maintenance 1. Regular Maintenance Items A If sprinklers have been replaced, were they proper replacements9 O Yes O No �i /A B Air leaks in dry-pipe system resulting in pressure loss more than 10 psi/week repaired? O Yes O No ZIN/A C.Dry-pipe systems being maintained in dry cendiuon? O Yes O No 2rN/A D Were any of the following discovered? O Yes eNo O NIA If yes, conduct an obstruction invecrtgarion CndJlush rile wfrem I Defective intake screen for pumps taking suction from open sources. 2 Obstructive material discharged during waterflow tests. 3 Foreign materials found in dry-pipe valves.check valves or pumps. 4 Heavy discoloration of water during drain test or plugging of inspectors tea connection. 5 Plugging of sprinklers found dunng activation or alteration 6 Plugging found in piping dismant!ed during alterations 7 Failure to flush yard piping or surrounding public mains following new insta)lauon or repays. 8 Record of broken mains in the vicinity, 9 Abnormally frequent false-tripping of dry-pipe valves 10 System is returned to service after an extended period out of service(greater than one year). I I There is reason to believe the system contains sodium silicate or its derivatives 2. Annual .Maintenance Items A Operating stem of all OS&1' valves lubncated,compietely closed, and reopened Yes 0 No Z N/A B. Interior of dry-pipe, preaction end deluge valves c;eaned' 3 Yes O No {fN/A C Low points drained in dry-pipe,preaction and deluge systems prior to the onset of freezing weather? O Yes O No KN/A D Sprinklers and spray nozzles protecting commercial cooking e 'ipment and ventilating systems replaced except for bulb-type which show no signs of grease buildup? O Yes O NofJ N/A Part III - Comments (Any "No"answers, test failures or other problems found with the sprinkler system must be explained here.) Part IV - Inspector's Information Rotundo Plumbing Corp. Po Box 9 Inspector Company, Hawthorne, NY 10532 Company's Address 914-579-0015 I certify t the mfonr,at o is coneet at the time and plach of my inspection,antl that all equipment tested at this time wac Pe tional du,en u c mpletion of this inspection excepi as noted in Pan III above - — Signature of Inspector or National Fire Sprinkler Association, P.O.Box 1000,Patterson,NY 12563 Shcct 3 of 3,Printed 7/92