Laserfiche WebLink
� <br />� <br />BACKWATER PREVENTION DEVICE FINAL <br />INSTALLATION CHECKLIST <br />Insfallation Compan� Name and Contact Inio: <br />- 7Go-k3 <br />Date Backwater Prevention device (BWD) was installed: ° Date this form was completed: <br />Installation Property O�vner ��ame and Coniacl info: S�+a; <br />Property Address: �`'I U�f C�-z,,. � %� S <br />Pre•Installation Inspection Checklist: <br />All items must be cfieciced 'Yas' rn order for a BIND to be considered lor installation <br />j <br />Is there a basement or level of the house lhat is al or near assumed sewer main elevalion? � Yes ❑ No <br />Are there fxfures in Uie house located below the upstream sevder manhole rim elevaiion? � Yes ❑ No <br />Is the side sewer currenlly UNPROTECTED from se�ver backups (does nol have a RWD installed)? � Yes ❑ No <br />Site Inspection Checklist: <br />f.11 ilems must 6e checked'Yes' before inspection is considered complete <br />Was side se�ver N inspected from building to sewer main? Q Yes ❑ No Contlition: _ <br />Does side sewer have at least 1% slop2 from the building fo see+er main? 0 Yes ❑ No Descrbe: <br />Have all building sewer drain connections tu fhe side se�ver been itlenlified and located? �Yes ❑ Nn <br />Have all properly slorm drainage connections to ihe side sewer been ideniified and located? 0 Yes ❑ No <br />Has property been evaluaied for drainage deficiencies wilh (indings communicated to property owner? � Yes ❑ No <br />installation Details: <br />VJhat type and brand of BWD was installed af lhis site (CIe2n Check BWV, Giinder pump, etc.): Lw���4 S I��•�� <br />UJhere �vas ihe device installed (general descriplion, aflach map)? ���� ��� ��, rG;/ fti �. c �. �.-c <br />�%c.: n � . tn,L <br />Was there any other sewer or slorm drainage tvork r,omplefed in conjunction �vilh ihe BUPD wark? Is so please describe: _ <br />/I /A <br />Installation Checklist: <br />Are all downspouis antl sile drainage disconnected irom upsiream of ihe BWD? �C] Yes ❑ No Commenis: _ <br />Doc, BWD �osilioning meels minimum slope reyuirement ol >1"/,�? [X� Yes ❑ No Comments: <br />Can BWD be pulied oul for inspection and maintenance after loosening lhumb scrr.w? � Yes ❑ Plo <br />Is BWD locked into the proper posilion and Ihumb scret�J tighlened? Q Yes ❑ No <br />� <br />Cirr,le the BWD cover. irriaation cover (landscape area) I(ra(fic load bearing cover (drive suriace) ! ccess hatch builtling) <br />INas property owner shown Ihe location oi the installed BWD? [] Yes ❑ No Commenls: ____ <br />Property Ov,ner's SignaWre: Dale: <br />InstallersSignature: `/'1,�/ �%zr-e—. Date: I a' S— I �{ <br />Revision: 2 1 Monday, September 15, 201� <br />