Laserfiche WebLink
BACKWATER PREVENTION DEVICE FINAL <br /> t #01/j/,p... <br /> INSTALLATION CHECKLIST <br /> Installation Company Name and Contact Info: CAW\P&fL1 PLuiiPj, )( ,,. C . <br /> Date Backwater Prevention device (BWD)was installed: �2to-t S Date this form was completed: S' Z"7 l r- <br /> Installation Property Owner Name and Contact Info: ' lilt i , <br /> Property Address: g 1063 f rk i - '' eiCH—C, _____ <br /> 11, <br /> Pre-Installation Inspection Checklist: <br /> All items must be checked `Yes'in order for a BWD to be considered for installation <br /> Is there a basement or level of the house that is at or near assumed sewer main elevation'? 2res ❑No <br /> Are there fixtures in the house located below the upstream sewer manhole rim elevation? Yes ❑ No <br /> Is the side sewer currently UNPROTECTED from sewer backups (does not have a BWD installed)? 2fes E No <br /> Site Inspection Checklist: <br /> All items must be checked Yes'before inspection is considered complete <br /> Was side sewer TV inspected from building to sewer main? es ❑ No Condition: <br /> Does side sewer have at least 1% slope from the building to sewer main? es ❑ No Describe: <br /> Have ail building sewer drain connections to the side sewer been identified and located? lages No <br /> Have all property storm drainage connections to the side sewer been identified and located? gYes U No <br /> Has property been evaluated for drainage deficiencies with findings communicated to property owner? ,-Yes ❑ No <br /> Installation Details: <br /> What type and brand of BWD was installed at this site (Clean Check BWV, Grinder pump,etc.): C. .t,c- &L-Q.c..,K- <br /> Where was the device installed (general description, attach map)? t", <br /> Was there any other sewer or storm drainage work completed in conjunction with the BWD work? Is so please describe:N.)6 <br /> Installation Checklist: <br /> Are all downspouts and site drainage disconnected from upstream of the B D? [J Yes 0 No Comments: <br /> Does BWD positioning meets minimum slope requirement of>1%? es Q No Comments: <br /> Can BWD be pulled out for inspection and maintenance after loosening thumb screw? (. Li No <br /> Is BWD locked into the proper position and thumb screw tightened? es No <br /> Circle the BWD cover i e area)I traffic load bearing cover(drive surface)I access hatch (building) <br /> Was property owner shown the location of the installed BWD? i s Li No Comments: <br /> 4 <br /> Property Owner's Signatu . ? ► Date:f <br /> Installer's Signature: .. 5-- <br /> `='4-► . <br /> ie Date: '" 7 f <br /> Revision: 2 1 Monday, September 15, 2014 <br />