Laserfiche WebLink
Irrigation System Assessment: (3 Water Conservation Points) <br />Name of Company Performing Assessment: <br />Technician Name: <br />Please provide an itemized copy of the original invoice with this form. <br />Phone Number <br />Assessment must include: Check all data sensors to ensure they are operational, program controller, inspect for leaks in heads and <br />distribution pipes, check for proper alignment of sprinkler heads <br />Landscaping: (8 Water Conservation Points) <br />Type of landscaping changes (circle al] that apply): Eco-Grass <br />Please Describe "Other' <br />Square Footage of Area: <br />Native/Prairie Grass Rain Gazden Black Dirt <br />Xeriscape Other <br />(area must be larger than Soo square feet to qualify) <br />Installation Person/Company: Phone: <br />Please provide an itemized copy of the original invoice and a simple sketch of work done with this form. <br />Water Conserving Indoor Equipment: (Water Conservation Points, See Below) <br />Type equipment installed (circle all that apply: Shower Head (t WCP) Toilets/Urinals (i WCP each) <br />Clothes Washer (z WCP) Dishwasher (z WCP) <br />Rock Gazden <br />Pre-Wash Dish Sprayer (t WCP) Faucet Aerators (t WCP all faucets) <br />(Requirements: Shower head t.S gpm or less, Toilets i.z8 gpf/Urinals o.S gpf, Clothes Washer s S.S Water Factor, <br />Dishwasher 4.zS gallons/cycle, pre-rinse Sprayer i.6 gpm, and Faucet Aerator < 2.~5 gpm) <br />Installation Date: (Copy of invoice with application required) <br />Type of Equipment Brand Name <br />t. <br />z. <br />3• <br />4• <br />5• <br />6. <br />7~ <br />MAIL TO: <br />Model No. WCPs <br />Elk River Municipal Utilities, C/O WATER CONSERVATION REBATE, P.O. Box 430, Elk River, MN 55330 <br />