Laserfiche WebLink
_ BACKWATER PREVENTIpN DEVICE FIIVAL <br /> INS.1'ALLATION CHE.CKL:IST <br /> Installation Company Nameand.Contacl Info:��,(' �/�,,,�i�� <br /> Date Baclnvater PreVenlion device(BV�'C�)v�as insfalled: I r 1� � Dale.this form tvas comp!eled: I 17I1 S <br /> Inslallation Property O���mer Name and Contact Info:�"Js7� }{PQ,VE1,� <br /> Propert)�Address: ��Z{s (�1}-p,,��, � <br /> Pre•Inshaliation Inspection Checklisl: ! <br /> All items must be chec,�ed'Yes'in o�derlor a BWD!0 6e coqsidered IorinstaC�ation <br /> Is Ihere a basemenl or leti�el oi tne house Ihat is at or near assumed sev:er main,elevalion?�]Yes ❑No <br /> r'.re there fixtwes in the house lo�ated below the upstream sewar m�nhole rim e(evaiion?�]k 1'es ❑(vo <br /> is the s�,e se:�:er curten(ly UNPROTECTED from se�•rer backups•(does.nof have.a.81NQ installed)1(�Yes ❑R!� <br /> Site Inspection.Checklist; <br /> A!1 ifems musf tie checked'Yes'bolo�e inspection is considered complele <br /> Was side sew�r N inspected.from bui!ding to sev�er,main? �Yes ❑No Condition; <br /> Does sidesew��have at least 1°5 slcpe from the building to_setiyer main? • �Yes (]No DescriCe: <br /> liave all building�sewer.drain'cunnecfions to the side set�recbeen identified and located? [�1'es ❑No <br /> Have;all,property sform drainag�c�nneclions to the side sewer been identified and.located? [Y��Yes ❑Ho <br /> Has propeiypeen e�aluated.for tlrainage deficiencies with findings communicated to property otimer? �,Yes ❑tdo <br /> Installation Detailsi <br /> Wliattype and tirarid of BWU M�a;insfallect at this site{C!es;,Check BINV, Grinde[pump,.etc.): C�c�,y1 L+ �� =� <br /> lNl�re.w2s�f•e de'vice inslalfed{general descnption,attaehm�p)? ���,� '(;�p <br /> �� —Y�►�l� , �.�� �'�G C0.A'�5 <br /> l�V�s Ihere any other,s,eln�er.or storm drainage w�rk completeei in conjunclion tivith;the BWD•work7 Is so please describe: <br /> h- lLQ� <br /> Installation Checklist <br /> Are all do�mspouts.and site drainage disr.onnected ircm upslream ui the B+ND? �j Yes ❑No Ce�nmenis: <br /> D,�es 64YD pcsif•oning meets ninirnu:n siope rouirement of:>1°6? [�1'es ❑No Gomments: <br /> Can BWD b�pulled'oul.forinsp�ction'antl'mainlenance afler leosening,thumtisc(e��? �1 Yes ❑N�J <br /> Is 814'D loc�ecJ irto Iheproper-posmonaLd�humt�scre��tighte.ned?. �.Yes ❑No , <br /> � __-_, <br /> Circ!e Ihe B',ND cov r�gation c�,¢e�(r e'area /ha�c load.bea�ng cover(drive surface)!aecess hatch(building) <br /> VJas property ovme.r shoK�n the location'of tlte installed BWD? ,��Yes ❑No Comments; <br /> Prope��tjO:�mers�Signatiire: .• .�'���i/� ��C�,_ � <br /> Date; /,-Z�; -/,T <br /> 1r15taller,s.5ignatufe;� ''� <br /> • ���� . Date:��� <br /> � Revisioni 2 " � � 1 . � Friday,Septembe�12,.7014. <br />