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Irrigation System Assessment: (g 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 />Assessment must include: Check all data sensors to ensure they are operational, program controller, inspect for leaks in <br />heads and distribution pipes, check for proper alignment of sprinkler heads. <br />Landscaping: (8 Water Conservation Points) <br />Type of landscaping changes (circle all that apply): Eco-Grass <br />Please Describe "Other" <br />Black Dirt <br />Native/Prairie Grass Rain Garden <br />Rock Garden Xeriscape Other <br />Square Footage of Area: <br />(area must be larger than 50o square feet to quality) <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 />(OFFICE USE ONLI~ <br />REBATE VERIFICATION: <br />Inspection Date: <br />pts Smart Controller <br />pts Landscaping <br />Time: <br />pts Water Conserving Indoor Equipment <br />TOTAL POINTS <br />pts Sprinkler Heads <br />pts Irrigation System Assessment <br />pts Participate in Project Conserve <br />MAIL TO: <br />Inspector: <br />Elk River Municipal Utilities, C/O WATER CONSERVATION REBATE, P.O. Box 430, Elk River, MN 55330 <br />