Engineering Questionnaire

 

You can use our online form below to submit the engineering questionnaire,
or you can print out the questionnaire by clicking here to download the PDF version.

Contact Information

Client Name (required)
Contact Name (required)
Address (required)
Phone (required)
Email (required)
Fax

Project Information

Project/Facility Name
Contact Name
Title/Position
Location Address
Phone
Country
Mobile Phone
Fax
Email
Requested Dates
for Project Start/Stop
Alternate Dates
For Project Start/Stop

Inspection

Date: Time of Inspection: Approx Temp:
Operating: Other:

Pipe Information

Municipal:  Sanitary (Gravity / Force Main) Storm Water
Private Sector:  Power Mining Refinery Chemical Process
 Other (specify other)
CCTV/Video Available:  Yes No Attached:  Yes No
(3MB max - file types: wmv,flv,mp4,mpeg,mov,3gp)
Pipe In Service:
Pipe Out of Service:
Total/Section Length:
Total Pipe System Length:
Drawing or Specification:  Yes No Attached:  Yes No
Attach: (2MB max - file types: jpg, pdf, gif, png, dwf,)
Type of Pipe:  RCP  PCCP  HDPE  PVC  Carbon Steel
 Ductile Iron  SS  CS  VCP  CMP  Aluminum

 Other (specify other)
Material Shape:  Round Box Elliptical Oval other
Dimensions: (w) (h)
If Oval, specify % of Ovality: (Percentage Change of Vertical Deflection over Mean ID of Pipe) If other, specify:
Thickness of Original Pipe: (in.) Current Thickness: (in.)
Determine if Partial of Fully Deteriorated:  Partially Fully
Application Internal/External:
Load:Depth of fill from invert in feet: Access End: Retraction End:
Diameters:
Design:  Curves/Radius  Joints  Elevations  Tees
 Insertion Ferrules  Taper  Sections  Flanges  Valves
 Other (specify other)
Type of Fill: (specify other)
Soil Compaction Percentage (100%, 90%, 80%):
Density of Soil (lb/ft3):
External Live Loading:
(specify other)
Approx. Surrounding Water Table: (Depth in Feet):
Access:
Manholes - Depth: ft. Length: ft.
Chimney - Diameter:in. Length: in.
Ring: Dia. in. Pipeline Intrusions Flush?  Yes No
If protrusion: in. Bench:  Yes No
 Flanged Valve Removal  Flanged Pipe Spool Removal
Weld / Re-weld Access Points By Others?  Yes No
 Excavation Trench Boxes Required?  Yes No
Approx Distance Between Access Points: ft.
Pipe Defects:
Cracks:  Longitudinal  Radial
Joints:  Separation in. Offset: in.
 Lateral Intrusions more than ¾ inch
 Spawls Diameter: in.  Depth in.
Dip:  Yes No Length: in.  Perforations Diameter: in.
 Corrosion  Erosion
Other: in.
Inflow/Infiltration:  Joints  Cracks  Other
Type of Infill:  Dampness  Weepers  Streams
Approx GPM: Effluent Type:

Effluent

Type (Be specific) Gas/Water/Oil/ Other:
GPM: % of Capacity: Time of Day Fluctuations:  Yes No
Explain:
Ambient: If not, Temperature: (Fahrenheit)
Slurry:  Yes No Type: Velocity:
Pressure:  Yes No
PSI: 		Vacuum:  Yes No
Mercury:
Design Pressure: Operating Pressure:
Test Pressure: Known Leakage/External Leakage:
Corrosion External: Corrosion Internal:
Chemical Composition: Chemical pH: % of Concentration
Use text box for All Chemicals:
Effluent Composition Schedule Available: Yes No Attached: Yes No
Attach:
(2MB max - file types: jpg, pdf, doc, docx, xls, txt, rtf)
Additional Comments or Concerns:

Logistics / Set up

Please try to provide pictures of access areas and surrounding areas.


(1MB max per file - file types: jpg, gif, png, pdf)
Rig Allowed in Facility:  Yes No
Distance From Pipe Access Point to Available Rig Location Area: ft.
Unusual Obstacles:  Yes No If yes, explain:
Vehicle Access: length:ft. width:ft. height:ft.
Are there any concerns with hydrocarbons in regard static ventilating the pipe?
 Yes No
Will the system need to be bypassed?  Yes No
Other requirements required in work area?:
Traffic Control Needed?  Yes No
What Type?  Flaggers  Arrow Boards  Signage
Surface Preparation (water jet/compressed air blast clean/ vacuum):
Standard Used for Surface Preparation:
Power Supply Available (is there site power nearby and useable):  Yes No
Volts:
Phase:
Amps:
kW(kVA):
Air Supply Available (is there site compressed air nearby and useable):  Yes No
PSI:
Bar:
CFM:
(me/min):
(l/s):
Additional Comments or Concerns:

Problem Description

Detailed Explanation:
Laterals: Size:
Type:
How many in manhole to manhole run?
Joints: Distance between:
Type:
Max:
Thickness of Original Pipe (Determine if Partial or Fully Deteriorated):

Additional Notes: