Laserfiche WebLink
INSTALLATION CHECKLIST <br />Installation Company Name and Contact Info: fib k✓i�f�%l Gih�2�' ate''�7 ��3 <br />Date Backwater Prevention device (BWD) was installed: j ' 1_ 1- 20l Sr Date this form was completed: 10 �L <br />Installation Property Owner Name and Contact Info: <br />Property Address: <br />Pre -Installation Inspection Checklist: <br />All items must De checked 'Yes'in order for a BWD to be considered for installation <br />Is there a basement or level of the house that is at or near assumed sewer main elevation? Yes [I No <br />Are there fixtures in the house located below the upstream sewer manhole rim elevation? Yes ❑ No <br />Is the side sewer currently UNPROTECTED from sewer backups (does not have a BWD installed)? [Yes [:]No <br />Site Inspection Checklist: <br />All items must be checked 'Yes' before inspection is considered omplete <br />Was side sewer TV inspected from building to sewer main? Yes ❑ No Condition: <br />Does side sewer have at least 1% slope from the buildidg to sewer main? � Yes ❑ No Qescribe: o r <br />uk <br />Have all building sewer drain connections to the side sewer been identified and located? uYes ❑ No <br />Have all property storm drainage connections to the side sewer been identified and located? d Yes <br />Has property been evaluated for drainage deficiencies with findings communicated to property owner? UNo <br />Yes ❑ No <br />Installation Details: <br />What type and brand of BWD was installed at this site (Clean Check BW Grinder pump, etc.): <br />Where was the device installed (general description,, map)? <br />Was there any other sewer or storm drainage work completed In conjunction with the BWD work? Is so please describe: hio <br />Installation Checklist: <br />Are all downspouts and site drainage disconnected from upstream of thp BWD? J Yes ❑ No Comments: <br />D <br />Does BWD positioning meets minimum slope requirement of>1%7 MYes ❑ No mments: /n <br />Can BWD be pulled out for inspection and maintenance after loosening -thumb screw? 9Yes ❑ No <br />Is BWD locked into the proper position and thumb scree, lightened? Yes ❑ No <br />Circle the BWD cover: irrigation cover (landscape area) t traffic loa bearing cover (drive surface) access Batch (building) <br />Was property owner shown the location of the installed BWD? Yes ❑ No Comments: Lro c <br />Property Owners Signature., Dat : - <br />Installers Signature' Date: I '11- ail S <br />Revision: 2 1 Monday, September15, 2014 <br />