Laserfiche WebLink
BACKWATER PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> Installation Company Name and Contact Info:A+ Sewer Technolonies U_C. 1888-213-76561 <br /> Date ba�kwater device(BWD) was installed: Date th�s form v�as compleled <br /> Installat�on Proper�, Jwner Name and Conlact Info: Jran Bartels j4251765-5697 jeannehartela53na.,,gmall com <br /> Property Address: 302 Alverson Blvd Everett WA 98201 <br /> Pre•Insfallation Inspection Checklist: <br /> All ifems musf be checked 'Yes'in order for a BWD to be considered for insfallation <br /> Is tnere a basement or level of the house that is at or near assumed sewer main elevation� ❑Q Yes ❑ No <br /> Are ihere(ixtures in ihe house located bebri the upslream seH • manhole rim etevation?[I Yes ❑ No <br /> Is Ihe side sewer currently UNPROTECTED from �:�vei backups (does nol have a B'ND installed�9�Yes ❑No <br /> Site Inspection Checklist: <br /> All items must be checked 'Ves'6efore inspecfion is considered complete <br /> N'as side sev�er T`/ inspected from bu�lding ro sev.er main7 ❑� Yes ❑ No Condit�on <br /> Does side sewer have al Icast 1%slope trom ihe huildmg to sewer main? 0 Yes ❑ No Describe: <br /> Have all buiiding sewer drain connect�ons to the side sevrer heen identified and localed? n Yes [� No <br /> Have all properly storm drainage conneclions lo the side sewer been idenlified and located7 �Yes ❑ No <br /> Has properly been evaluated for d�ainage deficiencies with lindings communicated to properly oa+ner? ��] Yes ❑'Jo <br /> Installation Detai�s: <br /> What type and brand ot BWD was installed at this site(Clean Check BWV,Grinder pump, etc.): Clean Check <br /> YJhere was ihe device installed (general descriplion, altach map)? <br /> l4'as ihere any olher se�ver or slorm drainage work completed in con�unc�ion�vilh ihe AdWD work?Is so p!ease describe. <br /> Installalion Checklist: <br /> Are all downspouls and site drainage disconnecled Irom upslream o(Ih BWD? Yes ❑No Commenls <br /> Uoes B'NV posilioning meef minimum siope requiremenl o(>t°a7 �es [] No C men�s <br /> Can BNN be pulled out lor inspecl�on and maintenance after loosen!ng I�umb scre�v? l�Ycs ❑"Ju <br /> Is BWV locked into the proper posilion and Ihumb screw lighlened� �f Yes ❑ No <br /> Circle Ihe BWV cover: irriya6on cover pandscape area)I traflic�d bearing cover(drlve sudace)I access hatch (build�ng) <br /> Was homeowner sho�vn the location of the installed ABWD? Yes ❑No Commenls: <br /> � ,� ^ `- <br /> Property O�vner's Signature: 5�'� ✓, Date: � <br /> Inslailer's Signaturel%� Ddte ��� ' �� <br /> Revision:l 1 Thursday, Octobei 02, 2014 <br />