Site Survey

Company Information (One Site-Survey Per Building)

Company Name:

Order# / Reference: (e.g.:ddmmyyIN0006)

Date:

Contact Name:

Title:

Phone:

Email

Property Address:

Hours of Operation:

Property Details

How many meters does this building have?

How many stories/floors?

Do you have a pump/meter room?

Yes
No

Do you have a booster pump?

Yes
No

Any issues/complaints with pressure or leaks?

Yes
No

Property/Business Type:

Meter 1 Details

The FCD Cannot Be Installed On Any Fire Line

Taking pictures: Select the specific Checkbox below to take that picture.
There are two link options: Upload Files, or, Upload Using Camera on a mobile phone.
NOTE: DO NOT use HEIC images. Set mobile phone for JPG image capture

--- Will only accept JPG, JPEG, or PNG images. ---

M1-1. Picture Taken:

When entering Meter Room / Vault

M1-2. Picture Taken of:

Building Isolation Valve

M1-3. Picture Taken of:

Connection (shutoff) prior to meter

M1-4. Picture Taken of:. Picture Taken of:

Other piping, elbows, & turns

M1-5. Picture Taken of:. Picture Taken of:

Connections to the meter (both Sides)

M1-6. Picture Taken of:

Connections / devices after meter

M1. Meter location:

M1. Meter Model:

M1. Meter Serial # :

M1. Flange Face Type

M1. Flange Bolt Pattern :

M1. Flange ASME Type:

M1. Pipe Size/Diameter:

Is the pipe size/diameter of your pipe change in size downstream after the meter throughout your property?

M1. Meter Size:

M1. Main Water Line Size:

M1. PSI at Meter (Before Backflow):

*Required - Please Check Backflow Certification For Reference (if any)

M1. PSI at Property (After Backflow):

M1. Bypass Valve Installed?

IMPORTANT DIRECTIONS FOR PHOTOS/PICTURES REQUIRED:

1. Meter Size And Pipe Diameter Size At The End Of The Meter, Confirmation Required
2. Flow Direction Of Your Water Is Required To Confirm - Arrows Usually Help Identify
3. Focus At the End/Outlet Of Meter - This Helps Us Determine Where The FCD Can Be Installed

M1. Meter Pictures:

Drag & Drop Files, Choose Files to Upload, or Capture With Your Camera You can upload up to 5 files.

Up Close and After The Meter Outlet Fitting or Flange

M1. Pipes/Plumbing Pictures:

Drag & Drop Files, Choose Files to Upload, or Capture With Your Camera You can upload up to 5 files.

Between Meter & Backflow (if any)

M1. Video URLs: YouTube, Google Drive, Dropbox links

M1. Video URL 1

M1. Video URL 2

M1. Video URL 3

M1. Video URL 4

M1. Additional Details & Notes: YouTube, Google Drive, Dropbox links

Meter 2 Details

The FCD Cannot Be Installed On Any Fire Line

Taking pictures: Select the specific Checkbox below to take that picture.
There are two link options: Upload Files, or, Upload Using Camera on a mobile phone.
NOTE: DO NOT use HEIC images. Set mobile phone for JPG image capture.

--- Will only accept JPG, JPEG, or PNG images. ---

M2. PSI at Meter (Before Backflow):

*Required - Please Check Backflow Certification For Reference (if any)

M2. PSI at Property (After Backflow):

M2. Bypass Valve Installed?

M2. Meter Pictures:

Drag & Drop Files, Choose Files to Upload, or Capture With Your Camera You can upload up to 5 files.

Up Close and After The Meter Outlet Fitting or Flange

M2. Pipes/Plumbing Pictures:

Drag & Drop Files, Choose Files to Upload, or Capture With Your Camera You can upload up to 5 files.

Between Meter & Backflow (if any)

M2. Video URL 1

M2. Video URL 2

M2. Video URL 3

M2. Video URL 4

M2. Additional Details & Notes: YouTube, Google Drive, Dropbox links

Meter 3 Details

The FCD Cannot Be Installed On Any Fire Line

Taking pictures: Select the specific Checkbox below to take that picture.
There are two link options: Upload Files, or, Upload Using Camera on a mobile phone.
NOTE: DO NOT use HEIC images. Set mobile phone for JPG image capture.

--- Will only accept JPG, JPEG, or PNG images. ---

M3. PSI at Meter (Before Backflow):

*Required - Please Check Backflow Certification For Reference (if any)

M3. PSI at Property (After Backflow):

M3. Bypass Valve Installed?

M3. Meter Pictures:

Drag & Drop Files, Choose Files to Upload, or Capture With Your Camera You can upload up to 5 files.

Up Close and After The Meter Outlet Fitting or Flange

M3. Pipes/Plumbing Pictures:

Drag & Drop Files, Choose Files to Upload, or Capture With Your Camera You can upload up to 5 files.

Between Meter & Backflow (if any)

M3. Video URL 1

M3. Video URL 2

M3. Video URL 3

M3. Video URL 4

M3. Additional Details & Notes: YouTube, Google Drive, Dropbox links

Meter 4 Details

The FCD Cannot Be Installed On Any Fire Line

Taking pictures: Select the specific Checkbox below to take that picture.
There are two link options: Upload Files, or, Upload Using Camera on a mobile phone.
NOTE: DO NOT use HEIC images. Set mobile phone for JPG image capture.

--- Will only accept JPG, JPEG, or PNG images. ---

M4. PSI at Meter (Before Backflow):

*Required - Please Check Backflow Certification For Reference (if any)

M4. PSI at Property (After Backflow):

M4. Bypass Valve Installed?

M4. Meter Pictures:

Drag & Drop Files, Choose Files to Upload, or Capture With Your Camera You can upload up to 5 files.

Up Close and After The Meter Outlet Fitting or Flange

M4. Pipes/Plumbing Pictures:

Drag & Drop Files, Choose Files to Upload, or Capture With Your Camera You can upload up to 5 files.

Between Meter & Backflow (if any)

M4. Video URL 1

M4. Video URL 2

M4. Video URL 3

M4. Video URL 4

Meter at Taken

M4. Additional Details & Notes: YouTube, Google Drive, Dropbox links

Meter 5 Details

The FCD Cannot Be Installed On Any Fire Line

Taking pictures: Select the specific Checkbox below to take that picture.
There are two link options: Upload Files, or, Upload Using Camera on a mobile phone.
NOTE: DO NOT use HEIC images. Set mobile phone for JPG image capture.

--- Will only accept JPG, JPEG, or PNG images. ---

M5. PSI at Meter (Before Backflow):

*Required - Please Check Backflow Certification For Reference (if any)

M5. PSI at Property (After Backflow):

M5. Bypass Valve Installed?

M5. Meter Pictures:

Drag & Drop Files, Choose Files to Upload, or Capture With Your Camera You can upload up to 5 files.

Up Close and After The Meter Outlet Fitting or Flange

M5. Pipes/Plumbing Pictures:

Drag & Drop Files, Choose Files to Upload, or Capture With Your Camera You can upload up to 5 files.

Between Meter & Backflow (if any)

M5. Video URL 1

M5. Video URL 2

M5. Video URL 3

M5. Video URL 4

M5. Additional Details & Notes: YouTube, Google Drive, Dropbox links

Water & Sewer Billing Details

Billing Cycle Start Day Of Month:

Utility Billing Platform Link:

Billing Username/Email:

Billing Password:

Upload Your Water Bills Here:

Drag & Drop Files, Choose Files to Upload, or Capture With Your Camera You can upload up to 6 files.

Notes:

1. Size of the pipe after the meter and joining (backflow) must be equal to the sum of the sizes of the meters or smaller, never greater than this. 2. Incoming pressure from the city or water supplier, the closest to the water meter or possible installation zone. 3. Attach photos of installation location.

Property Manager or Facilities Engineer

Contact Name:

Phone:

Title/Role:

Email:

Technician / Plumber Information

Company Name:

Contact Name:

Phone:

Email:

Authorization & Confirmation:

Additional Notes:

The valve CANNOT be installed on any fire line system. Please ensure that the meter(s) are not the same for fire.

I Have Confirmed These Statements:

-> I confirm and acknowledge that the information provided above does not have any fire system connected to the main water domestic feed.
-> I confirm that there are no further changes or fixes to occur after the photos and site survey has been submitted (includes any backflow updates or meter swaps).

Person Submitting Site Survey

Survey Submitted By :*

Survey Submitted By :

Email Address :*

Email Address :

Signature :

Clear Signature

Once survey is submitted our engineering team will review all the information provided and will update with any other required information.

Photo Examples Gallery

1. Upclose to Meter

2. Before & After Meter

3. End of Meter Connection / Outlet

4. Water Shut Off Valve

5. Pipes & Infrastructure Up To Backflow

6. Additional Photos