Laserfiche WebLink
BACKWATER PREV�NTION DEVICE F!NAL <br /> Q, INSTALLATION CHEC�(LIST <br /> --- ,�ruJri c��n �.��(��-,� � ����d� sc���zr, L Lc_ <br /> Instalia;ion Company Name antl Gortacl Info:.�Cr �.�_��- /�)<j 1'344 -C/Ci 5/1�� '-��rl� ��:ti.)"a�IO .��T� <br /> Gate 8ack::�ater Prevenlin�dewce(BINC)r�as inst211ed:���__Dcie Ihis form e:as comoleled:��_ <br /> Instailation Property Ov+ner Name and Contact Info: _��j���-�L �-�'-���"?��- c�i S�-�,�Q _ <br /> Prope 1y Address:.y��_���f'11�1�4��� "!.-9 a C�� — <br /> Pre•Installation ins�ection Checklist: <br /> 411 items must be checked'Yes'in order for a Q WD to be considered(or ins'allation <br /> Is there a basement or level of tne house that is al or near ass�med see�er main eievation7 [�Yes ❑No <br /> kre there fixtures in the house located belor�the upslream se�:�er m2nhole rim elevaUon7 i�.Ycs ❑ No <br /> is 'the side see�er currently UNPROTEC7t�from se:ve!backups (does not have a Bl•VD installed)?� Yes ❑ Uo <br /> Site Inspeciion Checklist: <br /> till items must be checked'Yes'6eiore irspection is consrderea compfete <br /> '.4'as side seti:�er T�l inspecte 1 trom building to sewer main? (� Yes ❑ No Condition: �(�x _____ ___.__ <br /> Goes side seerer have at leas' 1b/o slope from lhe building to see�er ma,n? (�Yes ❑ No Descriue: _ <br /> I I2ve all bui'ding se�,ver drain connections to Ihe side seti��er been identified and located? �Y�s `tJo <br /> F{ave all property storm drainage connections to the side ser�er bee� identifed and located? (,�I Yes ❑ No <br /> Has property been evaluated for drainage deficiencies wilh fndings communicated to property owner? �Yes [� No <br /> Instailation Details: <br /> !�Vhal type and brand of B�VD was inslalled at ihis site(Clean Check BWV, Grinder pump,etr,j�E��^ ���_, <br /> V��here was the device installed (yen�ral description, aftach map)? ��_G�.���,�� _�� <br /> !rJas fheie any other sewer or storm drainage work co�r�}ileled in conjunciiun�vith the EiWD e+ork? Is so piease describe:_ � <br /> `IeS� ��-(��'��---�r��. ��- ���,s.�',r _pi�,e,S-- - <br /> Installation Checklist: <br /> !ue all do�vnspouts and sile drainage disconnected from upsiream of the B�VD' �Yes ❑No Comments: <br /> Uaes HLND posi�ioning meets minimum s!ope re.yuirement of>1%? �l'es i._j fJo Comments__ __ .__ ___ <br /> Can BLND be pulletl oul(or inspection and rnainienance a(ter loosening thumb scre�'+7 (�Yes L�No <br /> Is BWD locked in�o the pro er�Qsilion and thumb scre�v Iighlened? �Yes [] No <br /> C�rc!e the BWD cov : �rrigationyover landscape area)I traffic load Ceanng cover(drive suriace)i access hatch (building) <br /> �::?s property ov+ner shov�n ihe lo�alion o(the instailed 84VD"? �I Yes ❑ No Commenls: <br /> > <br /> Property Ovdner's Signature: ' �,.�C W� �"� Date: � �� ���� <br /> Installer's Signature:_ �r _ Da(e: l/,�_ ____ <br /> -r� <br /> Rei�ision: 2 �� i fiiday, Septem6er l2, 701a <br />