Laserfiche WebLink
BACKWATER PREVENTION DEVICE FINAL <br />4zc.rr INSTALLATION CHECKLIST <br />Installation Company Name and Contact Info <br />Date Backwater Prevention device (BWD) was installed: ate this form was completed <br />Installation Property Owner Name a d Contact Info: <br />Property Address: 6v! 9`fJr o _ <br />Pre -Installation Inspection Checklistl/ <br />All items must be checkeu 'Yes' in order fora BVVD to be considered for installation <br />Is there a basement or level of the house that is at or near assumed sewer main elevation? I I Yes ❑ No <br />Are there fixtures in the house located below the upstream sewer manhole rm elevation? $ Yes ❑ No <br />Is the side sewer currently UNPROTECTED from serer backups (does not have a BWD installed)? Yes ❑ No <br />Site Inspection Checklist: <br />All items must be checked 'Vas' before inspection is considered complete <br />Was side sewer TV inspected from building to sewer main? Yes ❑ No Condition: <br />Does side sewer have at least 1% slope from the building to sewer main? 0 Yes ❑ No Describe: <br />Have all building sewer drain connections to the side sewer been identified and located? [,Yes ❑ No <br />Have all property storm drainage connections to the side sewer been identified and located? �A Yes ❑ No <br />Has property been evaluated for drainage deficiencies with findings communicated to property owner? 0Yes ❑ No <br />Installation Details: <br />What type and brand of BWD was installed at this sil <br />Where was the device installed (general description, <br />Grinder pump, etc.): <br />Was there any other sewer or storm drainage work completed in conjunction with the BWD work? Is so please describe. <br />Installation Checklist: <br />Are all downspo.ds and site drair,,ge disconnected from upstream of the BWD? � Yes ❑ No Comments: <br />Does BWD positioning meets minimum slope requirement of >t%? [AYes ❑ No Comments: <br />Can BWD be pulled out for inspection and maintenance after loosening thumb screw? 0 Yes ❑ No <br />Is BWD locked into the proper position and thumb screw tightened? 0Yes ❑ No <br />Circle the BWD cover: irrigation cover (landscape area) I traffic load bearing cover (drive surface) I access hatch (building) <br />Was property owner shown the location of the installed BWD? (rX Yes ❑ No Comments: <br />Property Owner's <br />Inslaller's Signalu <br />Revision: 2 <br />o/S <br />Date: <br />Date: <br />ay, September 12, 2014 <br />