Laserfiche WebLink
BACKWATER PREVENTION DEVICE FINAL <br /> �. INSTALLATION CHECKLIST <br /> Inslallation Company Name and Contact Info:��_PI A��'l;4� �'6'Y( l.� 0 l�t,� <br /> �ate Backeiater Prevenlion device(BWD)was installed:�_Date this form�,vas completed:� <br /> Installalion Property O�vner Name and Contact In(o:�Q.."e t'�„/A O�yO r <br /> PropertyAddress: �('�� � 11�51 �/� <br /> Pre•Installation Inspection Checklist: <br /> Ail ilems must be checked 'Yes'in order lor a BWD to be considered for installation <br /> Is lhere a basemenl or level o(the house lhal is al or near assumed sewer main elevation7(�Yes ❑ No <br /> Are Ihere fixtures in ihe house located below lhe upstream sewer manhole rim elevaGon? �Yes ❑ �Jo <br /> Is Ihe side sewer currently UNPROTECTED(rom sewer backups(does not have a 6WD inslalled)��Yes ❑ No <br /> Site Inspection Checklist; <br /> A!I ilems musl 6e checked'Yes'belore inspeclion is considered complete <br /> Was side sewer TV inspected (rom building to sewer main? (�Yes ❑No Condilion: <br /> Does side sewer have at least 1°/a slope irom the building lo sevrer main? �Yes ❑ No Describe: <br /> Have all building sewer drain conneclions lo lhe side sewer been identifisd and located? [�Yes ❑No <br /> Have all property storm drainage conneclions to ihe side se�ver been identified and located? '�]Yes ❑ No <br /> Has property been evaivated tor drainage deficiencies wilh findings communicated lo properly o�vner? ❑Yes ❑ No <br /> Ir,stallation Details: /� 1 <br /> What type and brand ot BWD was inslalled al this site(Clean Check BWV,Grintler pump,elc.): ue� Puc (3t,,� p <br /> Where v�as lhe device instailed (generai description,attach map)? tJ�� � 0�1- ��.i��Qw Sn��-l� ��I- <br /> ��4� <br /> Was there any olher se�ver or slorm drainage work completed in conjunction with lhe BWD work? Is so please describe:_ <br /> Installation Checklist: <br /> Afe all downspouts and site drainage diswnnecled from upslream of lhe BWD7 �Yes ❑No Comments: <br /> Does BWD posilioning meets minimum slope requirement of>1%7 Q Yes ❑No Comments: <br /> Can BWD be pulled out(or inspeclion and maintenance after loosening thumb screw? QYes ❑ho <br /> Is BWD locked into the proper position and Ihumb scre�;i lightened? [�1'es ❑No <br /> Circle the BWD cover: irrigalion cover(landscape area)1 tra(fic load bearing cover(drive surface)/access hatsh (building) <br /> Was property owner shovm Ihe localion of the inslalled BWD? �]Yes ❑ No Comments: <br /> Property Owner's Sign r � Dale: <br /> Installer's Signalure: __ Date: �b—'tX� —l� <br /> Revision: 2 1 Friday,September 12, 2014 <br />