Fire Hydrant Flow Request Form printable pdf download

CHARLOTTE FIRE DEPARTMENT

Fire Hydrant Flow Request Form

Note:

1. All information must be completed in order to process your request

(including email address!)

2. Fire hydrant(s) must be inside the City limits or with-in the City’s Extra Territorial Jurisdiction (ETJ). Hydrants

in other incorporated city limits cannot be tested by CFD.

Hydrant

Hydrant Location:

______________________________________ No. (If Known) _____________

Project Name:

__________________________________________________________________

Project Address:

__________________________________________________________________

Company Requesting:

__________________________________________________________________

Company Address:

__________________________________________________________________

Name of Contact:

__________________________________________________________________

Telephone Number:

(_____) - ________ - ________ email: _________________________________

Fax Number:

(_____) - ________ - ________

Purpose of Test:

__________________________________________________________________

Additional information:

__________________________________________________________________

Fire hydrant test fee is $170.00 per request . A completed test form is required for each test hydrant.

Check enclosed payable to “City of Charlotte”

___

If paying by credit card, contact the Fire Prevention Bureau Office to provide necessary information.

Allow 10 business days to receive test results. Inclement weather or holidays may delay request.

Mail or Fax To:

Charlotte Fire Department

OFFICE USE ONLY

Fire Prevention Bureau

Test Results:

500 Dalton Avenue

Charlotte, North Carolina 28206

Attention: Water Supply Officer

Test Date: _____ / _____ / _________ Time: ________

Fax: 704-336-5190/Office: 704-336-2101

Pressure:

Note: Hydrant tests are for needed fire flow

Static: ________psi

Residual: ________psi

calculations, and hydraulic calculations for fire

Flow:

sprinkler and/or standpipe design only. Not to

be used for the design of domestic systems.

Residual: __________ GPM

@20 psi: __________GPM

48 Hour Recorded Static Pressure:

High: ______ Low: ______ 48 Hr. Avg.______

Revised 8/5/15

Fire Hydrant Flow Request Form

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