Laserfiche WebLink
I <br /> ' <br /> i <br /> � BACKWATER PREVENTION DEVICE FINAL ` <br /> ; <br /> Q, INSTALLATION CHECKLIST ; <br /> � <br /> 1'►"1�(`i Ccz n ��'/� �cJ ^r 5�� SC.c ��'�', L LG � <br /> Instail2tion Company Nam�and Contact Info:S���,�'�'i�C C � ��y��S1� n��'t'�� �` ��'��n '"��k:� � <br /> Date Backwater Prevenllon device(BWD)�aas inslalled: ,� Dale this form�vas eompleted:_�z��.`.�`_ t <br /> i <br /> Inslallation Property Ownf r Name and Contact Info:�/^i f /?Dr,l "��C'O �� '" ���j� � <br /> ProperlyAddress:J1o�L��_�—���'�=� `� �� I <br /> Pre•Installation Inspeclion ChecklisL• j <br /> A!I ifems must be checked'Yes'rn o�der for a DV✓D lo be considered for installation i <br /> Is ihere a basemenl or level of Ihe house that is al or near assumed sewer main elevation?�Yes ❑ No ! <br /> Are iherc fixtures in the house loealed beiow the upstream sewer manhole rim elevalion?[�Fes ❑ No I <br /> Is the sitle sewer currently UNPROTEC7ED from sewer backups�does nol have a BWD installed)7[�'es ❑No j <br /> i <br /> Site Inspection Checklist: � <br /> ! <br /> All items musf be checked'Yes'before rnspec�ion is r,onsidered compfete �� <br /> 1Nas side sewer TV inspecletl trom building lo sewer main? �T'es ❑No Condilion:_ <br /> Does side sewer have at leasl 1%slope from lhe building to sewer main? �Yes ❑No Describe: , <br /> Have all building sewer drain connections lo lhe side sr.wer bcen idenlified and located? [�'es ❑ No i <br /> Have all property storrn drainage connections to the side sevaer been identified and loeated? �Yes ❑ No i <br /> Has property been evaluated for drainage deficiencies a�ith findings communicaled lo properiy owner? �(es ❑ No � <br /> Installation Details: � <br /> What type and brand o(RWD was inslalled at this site(Clean Check BWV,frinder pump,etc.):_ ���I�. �� ' <br /> Where was lhe device installed(general ne:.cription,aitach map)? ���"_�E`��'-'?���� '���GU� <br /> � <br /> Was there any olher sewer or storm drainage work completed in conjunction with lhe DWD�vork7 Is so please descnbe:_ � <br /> --- --------�n� -- ; <br /> Installation Checklist: <br /> Are all tlownspouts and site drainage disconnecled from upstream of the OWD? ��Yes ❑No Comments: � <br /> Does BWD posilioning meels minimum slope requirement of>1°In� �'Yes ❑ No Commenis:____—_ ; <br /> Can 8WD be pulled out br inspection and maintenanr.e afler loosening lhumb screw? ���'es ❑ Nn + <br /> Is OWD lor.ked into Ihe proper position and ihumb screw tightened? [�,Yes ❑ No <br /> Circie the BWD cover irngaGon cover(la dscape area)!trafiic load beanng co��er(drive surface)f access halch(building) <br /> �__-�.� <br /> Was property owner shown thc location of the inslalled BWD?�j �'es ❑ No Comments: <br /> �n � fo�ly � > � <br /> �_..,,,,., Datc: � _ � <br /> ��,,,,,,,ry Owner's Signature: ' S i" 1 `-{—t���' -- � <br /> Inslaller's Signalure:�� �,- .--- Dal�:_ �' � 1 � � � ; <br /> Revi�ion:7 1 Friday, Septembcr 77, 7014 . <br />