1914 MCDOUGALL AVE 2022-05-03 - Laserfiche WebLink

BACKWATER PREVENTION DEVICE FINAL 4M7_r INSTALLATION CHECKLIST I n can ` 'P G 1 5 - 5eca�y-t L- Installation Company Name and Contact Into:JC1--e Arcait--, 1Td»�91A Date Backwater Prevention device (BWD) was installed`4(4 Date this form was completed: Installation Property Owner Name and Contact Infoa. _McC S�Uf4x f= �j¢u — — Property Address: k_ )4 I( k g . t —1E M_ Pre -installation Inspection Checklist: All items must be checked 'Yes' in order fora BWD to be considered for installation Is there abasement or level of the house that is at or near assumed sever main elevation? Yes []No Are there fixtures in the house located below the upstream sewer manhole rim elevation? [P Y s ❑ No Is the side sewer currently UNPROTECTED from sewer backups (does not have a BWD insta'led)? [ yes ❑ No Site Inspection Checklist: All items must be checked 'Yes' before inspection is considered complete ^ -i Was side sewer TV inspected from building to sewer main? P Yes ❑ No Conditir n: C Does side sewer have at least 1% slope from the building to sewer main? (i Yes [ ] No Describe: Have all building sewer dmin connections to the side sewer been identified and located? Pas ❑ No MM Have all property storm drainage connections to the side sewer been identified and located? [)� Yes ❑ No Has property been evaluated for drainage deficiencies with findings communicated to property owner? �d Yes ❑ No Installation Details: What type and brand of BWD was installed at this site (Clean Check BWV, Grinder pump,etc.): l6ec c , Where was the device installed (general description, attach map)? ,ci--av L 4ar Let A&_ sLL _ Was there any other sewer or storm drainage work completedrin conjunction with the BWD work? Is so please describe: _ Installation Checklist: Are all downspouts and site drainage disconnected from upstream of the BWD? [Yes ❑ No Comments: Does BWD positioning meets minimum slope requirement of >1%? ' Yes ❑ No Comments: Can BWD be pulled out for inspecton and maintenance after loosening thumb screw? ( Yes ❑ No Is BWD locked into the proper posNond thumb screw tightened? 10 Yes El No rt anoncover lj Circle the BWD cover: ' andscape area) I traffic load bearing cover (drive surface) I access hatch (building) Was property owner shown the location of the installed BWD? [Kj Yes ❑ No Comments: Property Owners Signature: l Date: Installerns Signature: Date: Revision: 2 1 Friday, September 12, 2014