Laserfiche WebLink
BACKWATER PREVENTION DEVICE FINAL <br />INSTALLATION CHECKLIST <br />Installation Company Name and Contacf Info: � �� ���' <br />Date Backwater Prevention device (84VD) was installed: � �-5- �� _ Da,e this form was completed: C- 2�� 1 ti <br />Installation Property Owner Name and Contact Info: �^ �.-o V� w�c.��` � <br />Property Address: _� � Oldc,G��, �n��-- ��� — <br />Pre-Instaliation Inspection Checklist: <br />All ifems must be checked'Yes' in order for a BWD to 6e considered for installation <br />Is there a basemenl or level o( the house that is al or near assume� sewer main elevation7 � Yes ❑ No <br />Are there fiMures in the house located below the upsfream sewer manhole rim elevationl �] Yes ❑ No <br />�s the side seveer currently U�PROTECTED from setver backups (does not have a BYJD installed)?�j Yes ❑ No <br />Site Inspectlon Checklist: <br />All items must be checked'Yes' before inspection is consrdere�omplete <br />Was side sewer N inspected irom building lo sewer main? Yes ❑ No Condition: <br />Does side sewer have at least 1% slope from the building to sewer main? � Yes ❑ N9 Describe: _ <br />Have all building sewer drain connec6ons to the side sewer been identified and located? �(] Yes ❑ No <br />Have all property storm drainage connections to the side sewer been identified and lucated? � Yes ❑ No <br />Has property been evaluated for drainage deficiencies with findings communiG3ted to property owner? � Yes ❑ No <br />Installation Details: <br />What type and brand of BWD was installed at this s� <br />Where was the device installed (general description, <br />Was ihere any other se�ver or storm drainage <br />Check <br />i� conjunclion <br />etc.): <br />1� <br />the BWD work? Is so please describe: _ <br />Instaliation Cheeklist: <br />Are all downspouts and site drainage disconnected from upsiream of the B1ND7 [p Yes ❑ No Comments: <br />Does 8WD positioning meets minimum slope requirement of >1%? �Yes ❑ No Comments: <br />Can BWD be pulled out (or inspection and mainfenance after loosening thumb screw? � Yes ❑ No <br />Is BVJD locked into th proper o ilipaandlhumbssrew-ti9kit�nedl [� Yes ❑ No <br />Circle the BWD c er: ifrigation cover (landscape a�load bearing cnver (dri;e suriace)1 access hatch (buildin9) <br />Was property o�vne owrrihe��litSRa D? � Yes ❑ No Comments: __ <br />Property Owner's Signature: Date: <br />Installers Signature: � � � _ Date: S- �� - � � <br />Revision: 2 1 friday, September 12, 2014 <br />