Laserfiche WebLink
i <br /> � � � BACKWATER PREVENTION DEVICE FINAL <br /> �w����" INSTALLATION CHECKLIST <br /> � <br /> ; <br /> Inslal ahon Company Name and Conlacl Info �,�n'1 �('y�i 1.�� f'L 1,�,1�iS lil!(,�� <br /> i - <br /> Date Back�valer Prevention device (BIND)Has inslalled:�7d 5_ Date this form was compieted:S $ Zols <br /> I:�stal�ation Property Owner Name and Contact Inio: C��r�S e�,�j�+n�o i <br /> PropertyAddress 2y2G�___�ja�� ��i�u_P��i�ti_�___ ` _ <br /> Pre•Installation Inspection Checklist: ' <br /> �1�1 r;erns must Ge checke;.' 'Ye,;'m order lvr a BWD to b�considered(or installation <br /> I;, ihr,re a basement or leve,o(Ihe house thai is al or near assumed se�ver main eleva�ion? ��es `) 1Jo <br /> r�,re fhcre fixcures m ihr, housc lor,ated Uelov�ihe upstream;ewer manhole rim eleva!ion?��Yes ❑ No . <br /> Is Ihe side sev,er eurrenlly UNf'ROTECTED Irom sewer backups (does',not have a BWD installed)7 L� [] Na <br /> Site Inspection ChecklisL ' <br /> r".!�ifems musl be checked 'Ye:,'before insnection is considered comp�efe <br /> 1'Jas side sewer N inspected trom bwlding 10 setiver main? �%]'�es �_� No Conddion __ _ <br /> L:�es s�de sewer have al leas� 1°i� slope (rom the building lo seH�er main7 Yes ❑ No D Qscribe: _ ____ <br /> / � <br /> H:we all building ;ewer drain cunnections to Ihe side secaer been ideqtdied and lo�ated? �� Yes .] No <br /> Have aIl property slom�drairage connections to the side sewer been id�nlified and localed? [�es ❑ No - <br /> i Ias Froperty been evaluated for drainaye de(iciercies vaith findings communicated to propery owner? __ Yes ❑ No <br /> Installation Details: <br /> l��hal�y�;e:�nd �iand of BWD was inslalled at this site(Clcan Check DSNV, Grinder pump, etc ) _CIPa�.�a-�k _ <br /> ;':�here r;,a�.�ine dF���ice installed (yeneral descrniptron. alta/ch� n�.�p)� -7)`y`�c � �✓� /vp:_��,/e� f Ccii n�! <br /> �i� �LA4_�e a c�K '�" �-hOM ft��.nn�a�hC;n� - --- <br /> � - ---- '- �---�----�------- -�----- '.---- <br /> 4':a;; IherFl�iq� other se�ver or sfnrm drainage work completed in con�im¢hon with ihe BWD v;o�k? Is so pleasr,ciescnbe U o <br /> ---------- -- - — --------------I --- <br /> I�stallation Checklist: <br /> A r, ;�II cl��;�n:pout;:ind sdr, �rain2,ye disconnected irom upstream a(Iho BN'l1? [ Yes ❑ Na Cnmments _ _ <br /> D��es EiIND positioning mcets minunwn slope reqwremeni ot >1%7 [�es �_] No Cnmmarts� <br /> Crui 81ND Le pulled oul for inspection;ind rnalntenmice alt��r loosening Ihumb screw� (�s ❑ Nu <br /> I� HWD lor.ked fnto Ihe proper oosition aqd thumb scre��v 6ghtened? �Yes ❑ No <br /> ��W�'R C�v�r2 <br /> C�,rcle fhe Blh'D cover i��rer(landscape aiea) I traflic load 6ea ing r,over(drive suriace)I access ha(ch (buddinq) <br /> b!'a; property ne;ner shown Ihe Iocalio 'ot ihe�nsialled DI�VD� L es ❑ No Comments: <br /> / � ----- - <br /> �Prupeily0wner'sS�,yna�ure:�_ ��''�� � DA�e� r,f� ,'� 7c� �ti� <br /> -�--- <br /> r/ ' ' _._ <br /> In�tallcr's Signature �`�1.- -- _ � .�l�d�� D'ate: �.�.��_J�/�____ <br /> Rrvisirn ? ! Monday, Sep!ember 15,201d <br />