Laserfiche WebLink
I <br /> � <br /> BACKWATER PREVEMTIORI DEVICE FINAL ' <br /> INSTALL�4TION CHECKLIST ' <br /> � <br /> �• �-�d� : ea�7:l'� L L.G j <br /> 1'Yl(.'fii G�if"1 ,�'� � u ^h � � <br /> Inslallation Company Name and Conlact Info�S� r I� F � ' 'S( � -O,� i <br /> Date Backwater Preventior device(�WD)was instalted:�'J�,(�_�ale this form was completed • �' � r � <br /> Inslallalion Property Owner Name and Contact Info�SL����d[����" �7 f -�77 __. I <br /> Property Address:��,�� �Ci� !r 4-+-� �L.ZI:�z_— ����a`n� iI <br /> Pre-Installation Inspection Checklist� i <br /> All items musf be r.hecked 'Ves'in orde�lor a OWD fo 6e considered for installafion ! <br /> Is there a basement or level of the house Ihal is at nr near assumed sewer main elevation?(�Yes ❑No } <br /> Are ihere tatures in Ihe house located below the upslream sewer manhole rim elevaGon7�zj Yes ❑ No � <br /> Is Ihe side sewer currenUy UNPROTECTED irom sewer backups (does nol have a 8WD installedJ? [�Yes [J No � <br /> Site Inspection Checklist: <br /> � i <br /> l�Il items must b�checked '1'es'be(ore inspeclion is r.onsidered complefe /� ! <br /> Was side sewer TV inspecird irom building to sewer main7 (�Yes ❑ No Condition �� ����1�t. � <br /> Does side sewer have at least 1%slope irom the huilding to sewer main? �[Q Yes ❑ No Describe:__ i <br /> Have all building sew.er drain connr.ctions to the side sev�er been identified and lor.aied? �] Yes ❑No , <br /> Have all oroperty storm drainage cunneclions lo ihe side sewer been identified and lacated7 �]Yes ❑ No ! <br /> Has property been evaluated for drainage deficienc�es wRh findmgs communicated to property owne�? (�Yes ❑No I <br /> { <br /> Installation Details: ' <br /> INhat type and brand ot BWD�vas inslalled at this sile(Clean Check BWV, Grinuer pump,cte.):geC�L_�� � <br /> lNhere was the device installed (general desr.riplion, �tlach map)� ���?�,�,��:W��S��}[pl_L'� i <br /> — ---- i <br /> Was Ihere any olher sewer or slorm drainage N�ork r.omplvled in conjunction with Ihe BWD work?Is so p!ease dr,scribe: _ � <br /> �� O��C'�?e�l_ �i_r�f? -��P��CAc.n.el -- --- - .. _ __ t <br /> Installation Checklist: <br /> Are au downspouts and site drainage disconnecled frorn upstream of the(�VJD? ��Yes � ] No Commnnls'_____ __ ; <br /> Does BIND posiliomng meels minimum slope requirement ol>1%7 �(�Yes � � No Comments _. ___. __.._ � <br /> Gan BWD be pulled oul tor inspeclion and mainlenance alter loosenirig Ihumb scre�v? (�Yes [ � No � <br /> / <br /> Is 6WD lor.ked inlo thr, proper posit�on and thumb screw fightened? [�[Yes ❑ No �. <br /> , <br /> Circle lhe BWD cove rriqalion cover(la scapc area)I iraflic IoaA bearing cover (drive sudace)I ar.r,ess hatr.h(bulldiny) <br /> � -�-� <br /> Was property owner shown the location ot Ihe installed BVVU7 �Yes ❑ No Commenis: ____ ! <br /> � <br /> PropertyOwner'sSignature. �u+- ���— Dale: • 9 1.0/5� . _ ___ f <br /> Inslaller's Signaturec__�a -- -- Date �� �S i <br /> � <br /> Revision:2 1 Friday,September 12, 7014 i <br />