Irrigation Evaluation Form

Variance Type

Large Property Irrigation Variance

High-Efficiency Irrigation Variance

Irrigator Information

Irrigator's Name*

CT Irrigators License Number (J3 or J4)*

Meter #*

Meter Size*

Static Pressure Reading*

Customer Information

Customer Name*

Site Address*

Zip Code*

Phone Number*

Email*

Backflow Device

Is there a Backflow Device?*

Yes

Make*

Model #

Size*

Serial #

Controller Information

How many stations?*

Station 1-5

Station 1

Run Time

Zone Location/Plant Type

Comments/Action Taken

Type of Heads

Pressure (H or L)

Heads Too Low

Yes

Heads Not Vertical

Yes

Heads Broken or Missing

Yes

Heads Leaking

Yes

Nozzle Broken

Yes

Nozzle Wrong

Yes

Nozzle Clogged

Yes

Overspray

Yes

Pipe Leaking or Broken

Yes

Sprinkler Head Spacing

Station 2

Station 3

Station 4

Station 5

Verification*

Only press the submit button after you have completed all the station information for the system.

By selecting this checkbox you certify that the information provided is accurate.