Laserfiche WebLink
OOLBACKWATER PREVENTION DEVICE FINAL <br />TINSTALLATION CHECKLIST <br />11 l( (`i Ccis l 4:if r h G ^+ `3 ode 5&z. 'fir 1_ c_G <br />Installation Company Name and Contact In i .0 "6� [�i) -ctc5 I'Nr (,z%,)�Nl[) <br />Dale Backwater Prevention device (BWD) was installed _ Dated this form was completed: <br />Installation Property Owner Name and Contact Info: % ,,-Sq 1' -,CL --c 1O �Lo2_- �j`�•�� <br />Property Address: <br />Pre -Installation Inspection Checklist' <br />All items must be checked 'Yes' in order for a BWD to be considered for installation <br />Is there abasement or level of the house that is at or near assumed sewer main elevation? Yes []No <br />Are there fixtures in the house located below the upstream sewer manhole rim elevation? [Kj Yes ❑ No <br />Is the side sewer currently UNPROTECTED from sewer backups (does not have a BWD installed)? ('Yes [I NO <br />Site Inspection Checklist: IF <br />Yes <br />All items must be checked 'Yes' before inspection is considered complete /� — I <br />Was side sewer TV inspected from building.to sewer main? FC Yes ❑ No Condition: r�(DJ <br />Does side sewer have at least 1% slope from the building to sewer main? [FYes ❑ 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? Pyes ❑ No <br />property been evaluated for drainage deficiencies with findings communicated to property owner? 5'es ❑ No <br />Installation Details: <br />What type and brand of BWD was installed at this site (Clean Check BWV, Grinder pump, etc.):�� <br />Where was the device installed (general description, attach map)? AVd_ <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 downspouts and site drainage disconnected from upstream of the BWD? ["Yes ❑ No Comments: <br />Does BWD positioning meets minimum slope requirement of >1%? P Yes ❑ No Comments: _ <br />Can BWD be pulled out for inspection and maintenance after loosening thumbscrew? [ Yes ❑ No <br />Is BWD locked into the proper position and thumbscrew tightened? VJYes ❑ No <br />Circle the BWD cove : ' rrgalien cover landscape area) f traffic load bearing cover (drive surface) I access hatch (building) <br />Was property oomer shown t e ocalion of the installed BIND? S es ❑ No Comments: <br />Property Owners Signatur o') Date: J 1- g /5 <br />Installer's Signature: /6 Date: <br />Revision: 2 V // — 1 Friday, September 12, 2014 <br />