TITLE PAGE
TITLE PAGE
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DOCUMENT NO.
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CLIENT
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PROJECT #:
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DATE:
GENERAL INFORMATION
GENERAL INFORMATION
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PROJECT:
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JOB LOCATION:
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WELL #:
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WELL DEPTH (ft):
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OPERATOR:
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INSPECTOR:
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PUMP TEST START TIME:
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If the sanding rate exceeds the specifications, describe measures taken between tests. (This information can be entered into the Note box at the end of this form.)
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The maximum allowable sanding rate is 1 pt / 25,000 gal ~ 5 ppm (parts per million).
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Click the "Open Link" button to open a Technical Memorandum for Sand Infiltration Tests using the Rossum Tester.
http://roscoemoss.com/wp-content/uploads/techmemos/TechMemo005-7RossumTester_000.pdf
TEST # 1
TEST # 1
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(CLOCK) TIME (min)
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START:
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STOP:
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WELL FLOWMETER READING (gallons)
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BEGIN:
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END:
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PUMPING RATE (gpm):
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LENGTH OF TEST (min):
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CONTAINER VOLUME (gallons):
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TIME TO FILL (min):
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OUTLET VALVE FLOW (gpm) (The outlet valve should be calibrated to 0.5 gpm.)
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ROSSUM READING (ml)
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START:
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STOP:
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SANDING RATE (ml/min):
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SANDING RATE (ppm):
TEST # 2
TEST # 2
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(CLOCK) TIME (min)
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START:
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STOP:
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WELL FLOWMETER READING (gallons)
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BEGIN:
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END:
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PUMPING RATE (gpm):
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LENGTH OF TEST (min):
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CONTAINER VOLUME (gallons):
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TIME TO FILL (min):
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OUTLET VALVE FLOW (gpm) (The outlet valve should be calibrated to 0.5 gpm.)
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ROSSUM READING (ml)
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START:
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STOP:
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SANDING RATE (ml/min):
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SANDING RATE (ppm):
TEST # 3
TEST # 3
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(CLOCK) TIME (min)
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START:
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STOP:
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WELL FLOWMETER READING (gallons)
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BEGIN:
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END:
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PUMPING RATE (gpm):
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LENGTH OF TEST (min):
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CONTAINER VOLUME (gallons):
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TIME TO FILL (min):
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OUTLET VALVE FLOW (gpm) (The outlet valve should be calibrated to 0.5 gpm.)
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ROSSUM READING (ml)
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START:
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STOP:
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SANDING RATE (ml/min):
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SANDING RATE (ppm):
TEST # 4
TEST # 4
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(CLOCK) TIME (min)
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START:
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STOP:
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WELL FLOWMETER READING (gallons)
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BEGIN:
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END:
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PUMPING RATE (gpm):
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LENGTH OF TEST (min):
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CONTAINER VOLUME (gallons):
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TIME TO FILL (min):
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OUTLET VALVE FLOW (gpm) (The outlet valve should be calibrated to 0.5 gpm.)
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ROSSUM READING (ml)
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START:
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STOP:
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SANDING RATE (ml/min):
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SANDING RATE (ppm):
TEST# 5
TEST # 5
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(CLOCK) TIME (min)
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START:
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STOP:
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WELL FLOWMETER READING (gallons)
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BEGIN:
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END:
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PUMPING RATE (gpm):
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LENGTH OF TEST (min):
-
CONTAINER VOLUME (gallons):
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TIME TO FILL (min):
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OUTLET VALVE FLOW (gpm) (The outlet valve should be calibrated to 0.5 gpm.)
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ROSSUM READING (ml)
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START:
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STOP:
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SANDING RATE (ml/min):
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SANDING RATE (ppm):
TEST # 6
TEST # 6
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(CLOCK) TIME (min)
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START:
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STOP:
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WELL FLOWMETER READING (gallons)
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BEGIN:
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END:
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PUMPING RATE (gpm):
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LENGTH OF TEST (min):
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CONTAINER VOLUME (gallons):
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TIME TO FILL (min):
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OUTLET VALVE FLOW (gpm) (The outlet valve should be calibrated to 0.5 gpm.)
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ROSSUM READING (ml)
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START:
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STOP:
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SANDING RATE (ml/min):
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SANDING RATE (ppm):
TEST # 7
TEST # 7
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(CLOCK) TIME (min)
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START:
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STOP:
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WELL FLOWMETER READING (gallons)
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BEGIN:
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END:
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PUMPING RATE (gpm):
-
LENGTH OF TEST (min):
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CONTAINER VOLUME (gallons):
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TIME TO FILL (min):
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OUTLET VALVE FLOW (gpm) (The outlet valve should be calibrated to 0.5 gpm.)
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ROSSUM READING (ml)
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START:
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STOP:
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SANDING RATE (ml/min)
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SANDING RATE (ppm):
NOTES
NOTES
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If sanding rate exceeds specifications, describe measures taken between tests.
PHOTOS
PHOTO DOCUMENTATION
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Photo #1
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Description of photo
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Photo #2
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Description of photo
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Photo #3
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Description of photo
