Laserfiche WebLink
BACKWATER PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> Inslallation Company Name and Conlael Info� v L . -�`�'�-oiz3 <br /> Date Backwaler Prevention device(BWD)was install?d: i�-11'� �� ate this form was completed: — l l�{ " <br /> ,t � <br /> Installation Properiy Owner Name and Co�tact Info: rTl�l�'l- �v�"� <br /> PropeRy Address: �� > �2� � <br /> Pre•Installation Inspection Checklist: <br /> All ftems must be checked'Yes'irt orderlor a BWD to be considered for insfallation <br /> Is there a 6asement or level of the house that is at or near assumed sewer main elevalion? es ❑ No <br /> Are ihere fix.!ures in the house locaied below the upsiream sewer manhole rim elevation? es ❑No <br /> Is the side sewer currently UNPROTECTED ftom sewer backups(does nol have a BWD inslalled)7�j�+'�s ❑No <br /> Site Inspection Checklist: <br /> All items must be checked'Yes'6e%re inspection is considered complete �V� <br /> !/ <br /> Was side sewer TV inspecled from building to sewer main7 �`� ❑No CondiGon: G <br /> Does side sewer have al least 1%slope from the building lo sewer main? �s ❑No Describe: <br /> Have all building sewer drain conne�tions to the side se�ver been identified and located? �j]N�'s ❑No <br /> Have all property storm drainage connections lo the side sewer been idenlified and located? [�f�0 No <br /> Has property been evatuated for drainage deficiencies with findings communicated to property owner? [�`es � No <br /> Installation Details: ��� ��C������ <br /> Whal type and brand of BWD�vas installed at this s'e(Clean Check BW' inder pump,etc.):� <br /> Where was the devire inslalled(general descripfion,attach map)7 - <br /> Was Ihere any other sewer or storm drainage work com9�e�d in conjunclion wilh the BWC work? Is so please describe:_ <br /> � 1V(M� _� <br /> Installation Checklist: <br /> Are all downspouts and site drainage disconnected(rom upstream of the BWD9 es ❑No Comments: <br /> Does BWD positioning meets minimum slope requirement ot>1%7 es ❑No Commenls: <br /> Can BWD be pulled out for inspection and maintenance after loosening Ihumb screw7 es ❑ No <br /> Is BWD locked into lhe proper position and thumb screw tightene s ❑ No <br /> Circle the BWD cover:irrigalion cover(landsr,ape area) raffic load earing cover riv surfa�e access halch (building) <br /> Was property owner show�lhe lo alion of e' s alled B� es – o Comments: <br /> Pro er's Si natur� Date: c7'� � �'-1 �� <br /> Install Signature: � Dale: �,�� r vJJ� <br /> Revision:2 1 Friday,Septemher 12,201A <br />