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American Society of Sanitary Engineering PRODUCT (SEAL) LISTING PROGRAM Factory Audit Inspection Test Report

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American Society of Sanitary Engineering PRODUCT (SEAL) LISTING PROGRAM Factory Audit Inspection Test Report ASSE STANDARD # REVISED: 2011 Double Check Detector Fire Protection Backflow Prevention
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American Society of Sanitary Engineering PRODUCT (SEAL) LISTING PROGRAM Factory Audit Inspection Test Report ASSE STANDARD # REVISED: 2011 Double Check Detector Fire Protection Backflow Prevention Assemblies LABORATORY FILE NUMBER: LISTEE: SEAL #: MODEL # TESTED: MODEL SIZE: ADDITIONAL MODEL INFORMATION (i.e. orientation, series, end connections, shut-off valves): NUMBER OF SAMPLES SUBMITTED: NUMBER OF SAMPLES TESTED: DATE TESTING BEGAN: DATE TESTING COMPLETED: General information and instructions for the testing engineer: The results within this report apply only to the models listed above. There may be items for which the judgment of the test engineer will be involved. Should there be a question of compliance with that provision of the standard, a conference with the manufacturer should be arranged to enable a satisfactory solution of the question. Should disagreement persist and compliance remain in question by the test agency, the agency shall, if the product is in compliance with all other requirements of the standard, file a complete report on the questionable items together with the test report, for evaluation by the ASSE Seal Board. The Seal Board will then review and rule on the question of compliance with the intent of the standard then involved. Documentation of material compliance must be furnished by the manufacturer. The manufacturer shall furnish to the testing agency, a bill of material which clearly identifies the material of each part included in the product construction. This identification must include any standards which relate thereto. FACTORY AUDIT INSPECTION REPORT FORM ASSE STANDARD Revised 08/10/2012 PAGE 1 FIRST SAMPLE TEST RESULTS SECTION III 3.0 Performance Requirements and Compliance Testing 3.2 Hydrostatic Test of Complete Assembly What was the pressure used for this test? psi ( kpa) The test period was for: minutes Were there any leaks or indications of damage to the assembly? Questionable If questionable, explain: 3.6 Allowable Pressure Loss at Rated Flow Was the assembly installed per Figure 1? If no, explain: What was the rated water flow for the assembly? GPM ( L/s) What was the supply pressure used for this test? What pressure loss through the piping system (if any) was deducted? What was the pressure loss observed at flows of: GPM L/s psi (kpa) What was the pressure loss at: 150% of Rated Flow 200% of Rated Flow What was the maximum pressure loss observed at flows from (0) GPM to rated flow (both ascending and descending)? Did the pressure drop generally increase from static up to a flow of 50.0 GPM (3.15 L/s) with a maximum total downward deviation of 10% from the highest previous value at any point? Was there any damage or permanent deformation of the internal components of the assembly? Was the assembly on test in complete compliance with the criteria of Section 3.6? 3.8 Drip Tightness of First Check _What was the initial height of water in the sight glass at test cock #2: inches ( mm) #2 and #3? inches ( mm) FACTORY AUDIT INSPECTION REPORT FORM ASSE STANDARD Revised 08/10/2012 PAGE 2 3.9 Drip Tightness of the Second Check _What was the initial height of water in the sight glass at test cock #4: inches ( mm) #3 and #4? inches ( mm) 3.10 Drip Tightness of Bypass Check (For DCDA-II Assemblies) _What was the initial height difference between the two sight glasses? inches ( mm) What was the final height difference between the two sight glasses? inches ( mm) FACTORY AUDIT INSPECTION REPORT FORM ASSE STANDARD Revised 08/10/2012 PAGE 3 SECOND SAMPLE TEST RESULTS* *A second sample shall only be tested if the first sample failed the necessary test sections. SECTION III 3.0 Performance Requirements and Compliance Testing 3.2 Hydrostatic Test of Complete Assembly What was the pressure used for this test? psi ( kpa) The test period was for: minutes Were there any leaks or indications of damage to the assembly? Questionable If questionable, explain: 3.6 Allowable Pressure Loss at Rated Flow Was the assembly installed per Figure 1? If no, explain: What was the rated water flow for the assembly? GPM ( L/s) What was the supply pressure used for this test? What pressure loss through the piping system (if any) was deducted? What was the pressure loss observed at flows of: GPM L/s psi (kpa) What was the pressure loss at: 150% of Rated Flow 200% of Rated Flow What was the maximum pressure loss observed at flows from (0) GPM to rated flow (both ascending and descending)? Did the pressure drop generally increase from static up to a flow of 50.0 GPM (3.15 L/s) with a maximum total downward deviation of 10% from the highest previous value at any point? Was there any damage or permanent deformation of the internal components of the assembly? Was the assembly on test in complete compliance with the criteria of Section 3.6? 3.8 Drip Tightness of First Check _What was the initial height of water in the sight glass at test cock #2: inches ( mm) #2 and #3? inches ( mm) FACTORY AUDIT INSPECTION REPORT FORM ASSE STANDARD Revised 08/10/2012 PAGE 4 3.9 Drip Tightness of the Second Check _What was the initial height of water in the sight glass at test cock #4: inches ( mm) #3 and #4? inches ( mm) 3.10 Drip Tightness of Bypass Check (For DCDA-II Assemblies) _What was the initial height difference between the two sight glasses? inches ( mm) What was the final height difference between the two sight glasses? inches ( mm) FACTORY AUDIT INSPECTION REPORT FORM ASSE STANDARD Revised 08/10/2012 PAGE 5 TESTING AGENCY: ADDRESS: PHONE: FAX: TEST ENGINEERS: We Certify that the evaluations are based on our best judgements and that the test data recorded is an accurate record of the performance of the device on test. SIGNATURE OF THE OFFICIAL OF THE AGENCY: TITLE OF THE OFFICIAL: DATE: SIGNATURE AND SEAL OF THE REGISTERED PROFESSIONAL ENGINEER SUPERVISING THE LABORATORY EVALUATION: SIGNATURE: COMMENTS: PE SEAL *To insert images into document (PE seal and signatures) Adobe Acrobat Pro users: At the top of the page, go to: Tools Advanced Editing TouchUp Object Tool. Once you have selected TouchUp Object Tool, right click within the document and select Place Image. Choose the image you want to place (PE seal or signature) and then select Open. Once the image is in the document, move and re-size the image accordingly. Save and send to ASSE. Adobe Reader users: Adobe Reader does not allow users to place images into the document. You must print this completed document and then sign and stamp the PE seal by hand. You may then send the completed document to ASSE via fax or mail, or you can scan the completed document and send via . FACTORY AUDIT INSPECTION REPORT FORM ASSE STANDARD Revised 08/10/2012 PAGE 6
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