Laserfiche WebLink
�ACK1M/�Y�� PRE�'EiVTIOF! DEVICE FIfVAL <br />I�i�3AL�.AiInN CHECKLISi <br />Instailation Co�ipany Name and Conlact <br />Date Bac�•�ater Prevenlion deviee (QVJD <br />1 � <br />Irsla;'ation Property Owner Name and Conlact Info: _'_ �G�— � ax7 —.. ��-�=Q��.�'— <br />,�rx�r� c��n ��;/��-, ���� �de se���.r, L LC� <br />Froperty Address: <br />Pre-Installation Inspection Checklist: <br />AA items must be checked 'Ves' in order (or a BVJD to be consiae�ed for installatien <br />Is �nere a basement or leve! ot ,he house ihat is a: or near assumed se�ver main eleva6on? (�Yes ❑ No <br />Are ihere fixiures in the house located belo�•� Ihe u�s(ream se�;;er manhote rim elevafon? � Yes ❑ N� <br />'s tha s!�P. SP.:'�er currentiy UNPROTEC7ED irom se :�er bac�cups (tloes not have a BN1D inslal!ed)? �1'es ❑ No <br />Site Inspectlon Checklist: <br />A!I items must be checked 'Yes' be'ore inspecticn �s ccnsidered complete I <br />l��as side see�er TV inspect2d from building to see:er main? t� Yes ❑ No Condilion '=i( ��1 <br />Dces side se�:�er have at leasi 1°h stope irom the building to see:er main? � 1'es ❑ No Describe: <br />Have all building se�ver dran connecPons to the side se�ver been identi(ied and loea!ed1 �Yes ❑ Nc <br />Have all properly srorm tlrainage ccnner,tions to Ihe side sewer been ideniifietl and located7 [�Yes ❑ �o <br />Has property been evaluated (or drainage deficienciee v��ith f�ndings communicated to propety owner? �j'Yes ❑ No <br />Installation Details: <br />1�Jhat type and brand nt BVJD �vas installetl at ihis site (Clean Check [3WV, Gr•nder oump, etc.): P'- "� <br />!�Jiiere evas ihe device installed (ge�ieral descrip' on, aflach map)? CL'.C' _(�''��CLL'_�U��{-- ._ S � <br />I�Jas there ai�y other se���er or storm drainage s�:ork completed in conjunction �vith the OWD �vork? Is so please describe: _ <br />1 <br />Installation Checklist: <br />Are all dovmspouls and site drainage disconnected from upstream n` ihe BIVD? � Yes ❑ No Commenfs: <br />Caes BIN� positioning meels imnimmn slope requirement of >19'0? (�� Yes (] ho Comments: <br />Can BWO he pulled nut (or inspeclion and maintenance after loosening thumb screw7 �Q Yes ❑ No <br />Is BIND for,ked inlo lhe proper �osi�ion and thumb screw ,ightened? �� Yes L.J No <br />Circle the BWD cov r. irngdtion c� r I ndscape area)/ traifle load ber� mg cover (drive surface) ! access halCh (building) <br />l4'as property owner��rfi�lo�alion of Ihe inslalletl BWD? �Yes ❑ No Comments: _ <br />%I / <br />'roperty O�mer's Signature: [vuv'{� `� `/`'u` ��t'�' Date: 2 � � � � <br />�falier's Signalure: _ f�_f,_� Dale: �1 <br />GU . <br />sinn: ? 1 Friday, Septemher 12, 7014 <br />