Laserfiche WebLink
; <br /> BACKWATER PREVENTION DEVICE FIN/�1L � <br /> INSTALLATION CHECKLIST � <br /> i <br /> �'Y�(`i Cc-eC1 `'�X'.�t'�� ^f� `�� .SC�-��-('� L LG i <br /> P Y � �C' C ' `t����I SC �,i�ri, �`N.� ��i .�J�' i <br /> Installation Com an Name and Contacl Info:� / �� -�= .� <br /> Date Backwaler PrevenGon device(9WD)was instalied:���f D��e this form was compleled:�.�7�.'�. i <br /> Installation Property Owner Name and Conlact In(o:�q�,�� -�- �P_.V'Yl��nr��___���., p"��-' 3 h'�' '���� : <br /> � -, p ��C?1 � <br /> Properly Address:��,,z!� �f �r �� ��'��� � <br /> i <br /> Pre-Installation Inspection Checklist: <br /> All items must be checked'Ves'in order(or a QWD to 6e considr.red for in;tallatron ; <br /> Is there a Lasemenl or Ievel of the house ihal is at or near assumed sewer main elevation�es ❑ No ; <br /> Are there'��ctures in ihe house lor.ated below Ihe upstream sewer manhole rim elevation? Yes ❑ No � <br /> Is '.he side sewer currently U1�'PROTECTED from sewer backups (does not have a BWD installed)?�es ❑ No � <br /> Site Inspection Checklist: � <br /> Afl items must be checked'Ves'before rnspection is considered complete I <br /> Was side sewer TV insner,led irom building to sewer main? I�Yes ❑ No Condihon:__�_ � <br /> Does side sewer have at least 1°�6 stope from the huiiding to sewer main? �Yes ❑No Describe:_ � <br /> Have all building sewei drain conmctions to ihe side sewer been ider,�ified and located? ��t1Yes ❑ No - <br /> i <br /> Nave all property slorm drainage connect�ons lo the side sewer been identified and Iocated7 �es ❑ No � <br /> Has property been evaluated for drainage deficiencies with findings communicated to property owner? �Yes ❑ No ! <br /> i <br /> Installation Details: / <br /> INhat type and brand o(RWD was inslalled at this site (Clean Check BWV, Grinder pump, etc.):���'«1� ! <br /> Where was Ihe device installed(general descnption, atlach map)'? + ���/:����5_ _� A( A I� � <br /> � <br /> l4ias there any other sev+er or storm drainage vrork completed in conjunction with Ihe BWD work? Is so please descnbe:_ ` <br /> � <br /> � <br /> ------ --- u� - - -- - ; <br /> Installation Checklist: <br /> Are all downspoufs and site drainagr disconoected from upsirr.am of the RWD'? (�Nes ❑N� Cammenls _ � <br /> Does BWD positionirg meets minimum slope requirement of >1%� �Yes �]No Commenis __ ! <br /> Can BWD be pulled oul tor inspection and maintenance afler loosening Ihumb scre�v? �}Xes ❑ No i <br /> Is DWD locked into ihe proyer�osilmn and thumh screw tightr,ned'? (�Yes ❑No ` <br /> i <br /> Grcle Ihe BWD cov . irriyation cover ddscape a�ea)I Iraffic load bearing cover(drive surface)I a�cess hatch(6uilding) � <br /> lNas proparty otivner s o�vn the location oi ihe installed BWD?�Yes ❑ No Commenis:`_ j <br /> Property Owner's Signature: � 7/��� Date: "'"' • t�� ; <br /> \ I � ,_ � <br /> Installer's SignaWre: � �f7 �ate. ____ <br /> /i" / � <br /> Revision:2 "�� � l F�iday, Septem6er 12,2014 <br /> t <br /> _ <br /> 1 <br />