Gananoque - BSI Online.CA

The Town of Gananoque requires an individual survey for each meter located at the premise.
If you are inspecting a location with more than one meter, you must submit multiple reports.

"*" indicates required fields

General Survey Information

CCN*

Meter Number*

Property Occupant*

Phone*

Report Given To*

Date of Survey*

Service Address*

Street Address City Province Postal Code

Mailing Name

Mailing Address*

Street Address City Province Postal Code

Is there a Domestic Cold Water Service*

Yes

Domestic Water Connection

Hazard Level*

Minor

Moderate

Severe

Location*

Bypass Around Water Service

Is there Acceptable Protection in Place?*

Yes

Surveyor Recommendations

Please provide suggested type/make/model/size or any corrective action needed.

Date of Last Test

Device Type*

Device Serial Number*

Size*

Make*

Ames*

Apollo*

Conbraco*

Febco*

Watts*

Wilkins*

Other Make and Model*

Is there a bypass?*

Yes

Bypass Information

Device Type*

Date of Last Test

Device Serial Number*

Size*

Bypass Make*

Ames*

Apollo*

Conbraco*

Febco*

Watts*

Wilkins*

Other Make and Model*

Is there a Fire Suppression System*

Yes

Fire Service Connection

Class*

Chemical*

Location (room)*

Meter Number

Hazard Level*

Minor

Moderate

Severe

Isolation*

Premise

Zone

Acceptable Protection in Place*

Yes

Surveyor Recommendations

Please provide suggested type/make/model/size or any corrective action needed.

Date Last Tested*

Fire Device Type*

Fire Device Serial Number*

Fire Device Size*

Fire Device Make*

Ames*

Apollo*

Conbraco*

Febco*

Watts*

Wilkins*

Other Make and Model*

Is there a bypass on the Fire System?*

Yes

Fire System Bypass Information

Fire System Bypass Device Type*

Date of Last Test

Device Serial Number*

Size*

Fire System Bypass Make*

Ames*

Apollo*

Conbraco*

Febco*

Watts*

Wilkins*

Other Make and Model*

Is there an Irrigation System?

Yes

Irrigation System Connection

Hazard Level*

Minor

Moderate

Severe

Is it metered?*

Yes

Meter Number*

Location*

Bypass Around Water Service

Acceptable Protection in Place for Irrigation Device?*

Yes

Surveyor Recommendations

Please provide suggested type/make/model/size or any corrective action needed.

Date of Last Test

Irrigation Device Type

Irrigation Device Serial Number*

Irrigation Device Size*

Irrigation Device Make*

Ames*

Apollo*

Conbraco*

Febco*

Watts*

Wilkins*

Other Make and Model*

Is there a bypass on the Irrigation System?*

Yes

Irrigation System Bypass Information

Irrigation System Bypass Device Type*

Date of Last Test

Device Serial Number*

Size*

Irrigation System Bypass Make*

Ames*

Apollo*

Conbraco*

Febco*

Watts*

Wilkins*

Other Make and Model*

Is there an Auxiliary Water Source

Yes

Auxiliary Water Connection

Hazard Level*

Minor

Moderate

Severe

Location*

Bypass Around Water Service

Meter Number*

Is the auxiliary connection connected to the municipal water supply?

Yes

Acceptable Protection in Place for Auxiliary Water Connection?*

Yes

Surveyor Recommendations

Please provide suggested type/make/model/size or any corrective action needed.

Date of Last Test

Auxiliary Water Connection Device Type*

Auxiliary Water Connection Device Serial Number*

Auxiliary Water Connection Device Size*

Auxiliary Water Connection Device Make*

Ames*

Apollo*

Conbraco*

Febco*

Watts*

Wilkins*

Other Make and Model*

Is there a bypass on the auxiliary water connection?*

Yes

Auxiliary Water Connection Bypass Information

Auxiliary Water Connection Bypass Device Type*

Date of Last Test

Device Serial Number*

Size*

Auxiliary Water Connection Bypass Make*

Ames*

Apollo*

Conbraco*

Febco*

Watts*

Wilkins*

Other Make and Model*

Is there Process Water Connection?

Yes

Process Water Connection

Hazard Level*

Minor

Moderate

Severe

Location*

Bypass Around Water Service

Meter Number*

Acceptable Protection in Place for Process Water Device?*

Yes

Surveyor Recommendations

Please provide suggested type/make/model/size or any corrective action needed.

Date of Last Test

Process Water Device Type*

Process Water Device Serial Number*

Process Water Device Size*

Process Water Device Make*

Ames*

Apollo*

Conbraco*

Febco*

Watts*

Wilkins*

Other Make and Model*

Is there a bypass on the process water connection?*

Yes

Process Water Connection Bypass Information

Process Water Connection Bypass Device Type*

Date of Last Test

Device Serial Number*

Size*

Process Water Connection Bypass Make*

Ames*

Apollo*

Conbraco*

Febco*

Watts*

Wilkins*

Other Make and Model*

Is there a 2nd Domestic Cold Water Service?

Yes

Domestic Cold Water Service #2 Connection

Hazard Level*

Minor

Moderate

Severe

Location*

Bypass Around Water Service

Meter Number*

Acceptable Protection in Place*

Yes

Surveyor Recommendations

Please provide suggested type/make/model/size or any corrective action needed.

Date of Last Test

Device #2 Type*

Device Serial Number*

Size*

Device #2 Make*

Ames*

Apollo*

Conbraco*

Febco*

Watts*

Wilkins*

Other Make and Model*

Is there a bypass on the 2nd Connection?*

Yes

2nd Connection Bypass Information

2nd Connection Device Type*

Date of Last Test

Device Serial Number*

Size*

2nd Connection Bypass Make*

Ames*

Apollo*

Conbraco*

Febco*

Watts*

Wilkins*

Other Make and Model*

Comments

Surveyor Information

Name of Certified Tester*

First Last

Tester Email*

Phone

Business Name*

Testing Company Address

Street Address Address Line 2 City Province Postal Code