Laserfiche WebLink
�A�B�lfilAT�R F'R�i/ENT@�Pl DEi,�BC� FIf�AL_ <br /> d QIV�Ts4LLATION CH�CF(LlS�' <br /> � . <br /> Installalion Company Nzme and Contacl In(o:�,��(' ;.��r,.� ,_ <br /> Date Backwater Prevenlion device(BWD)�:�as installed: � g I 'rJ Date ihis form was compieted: I � t J <br /> Installation Property Owner Vame and Conlact In{o' �G.Y� ���Yl <br /> Propery Address: I�l $ �."IYG�� �' <br /> Pre•Installation Inspection Checklist: <br /> All items musf he checked Yes'in order(or a Bl4iD to be considered(or installatron <br /> Is there a basement or 1ev21 oi Ihe house that is ai or ne2r assumed sewer main elevation?[�Yes ❑ ��o <br /> Are Ihere fixtures in Ihe hous= located below ihe upslream sewer manhole rim etevation?�Yes ❑ No <br /> Is the side sev�er currently UNPROTECTED from sew2r backups(does not have a Bl4�D instailed)? [�('es ❑ No <br /> Site Inspection Checklist: <br /> All items must be checked 'Yes'belore inspection is considered complete <br /> Was side sewer TV inspectetl trom building to sewer main? �Yes ❑ No Condition: <br /> Does side sewer have at least 1%slopa`iom the buiiding (o sev+er main7 (�'Yes ❑ No Describe <br /> H2ve all building seti•�er drain conneclions to the side sev+er been identified and lo�ated� �Yes ❑ No <br /> Have all property storm drainage connections to Ihe side sewer been identified and located? �(i'es ❑�o <br /> Has property been evaluated for drainage deficiencies �vith fintlings communicated to property owner7 �es ❑ No <br /> Installation Details: <br /> What type and brand of BWD was inslalled at Ihis sile(Clean Check BWV, Grinder pump.etc.):�(�X���_ <br /> 1h'here was lhe deviee inslalled (general description, attach map)? ��1/� r,r(,L�1_��1(�°�Q , <br /> T•-- <br /> Was Ihere any other sewer or storm drainage woik :ompleted in conjunclion with the BWD work7 Is so,�lease describe: <br /> y� S " I ��.�LAf"S�' {'�-� I�U S <br /> Installation Checklist: ,L <br /> Are atl do�vnspouls and site drainage disconnecled(rom upstream of Ihe BWD? �J Yes ❑No Cammems: <br /> � <br /> Does BWD positioning meets minimum slope requiremenl of >t%? �'es ❑ No Comments: <br /> L'an BNlD be pulled oul for inspeclion and maintenance aHer I, ••sening ihumb screw?� Yes ❑No <br /> Is BWD�ocked in(o lhe proper position and thumb screw tighlei., i? [�Yes ❑ No <br /> � - <br /> Circ!e ihe BWD cover. irrigalion cover(landscape area)I traffic load bearing cover(drive surface /access halch(building) <br /> 4Vas property owner shown Ihe location nf ihe installed BWD? �Yes ❑No Comments: <br /> � <br /> Properiy Ov+ner s Signalure: �A�,(�� _. Date: I�) 9l/S— <br /> Ins�aller's Signalure: f%/fi���!� -�`�� � Dale: � 1 s <br /> Revision; 2 1 Friday, September 12, 2014 <br />