2306 PINE ST 2022-05-04 - Laserfiche WebLink

BACKWATER PREVENTION DEVICE FINAL F,, INSTALLATION CHECKLIST � � i Installaiion Ccmpany Name and Contacl Info:�,�' J�0!'�l�C�uG� � �' �o O�r �U�—y�� Date Backwater Prevention devlce(BWD)was installetl:� � � � Date this form was completed:�,� ��I� � 1 (� � � Instailation Prope�iy Owner Nar��2ntl Cbnlac[inf6: 1 S�l�('J� , �UL�Rc7� i Propeity Address: ��Qr�_ W�, ' � Pre•Inslallation Inspection Checklist: i Af!items must be checked'Yes'in order lor a BVVD to be consrdered for installation ! Is there a basement or level of the house that is at or near assumed setiver main elevation? �Yes ❑No � Nre there fixtures in the house located below the upstream seti�rer manhole rim eleva'ion9�Yes �No Is the side sewer currenily UNPROTECTED from se�;�er backups(does not have a BWD installec)7 �Yes ❑ No � Site Inspection Checklist: � All items musf be checlred'Yes'belore inspectia�rs considered complete I Was side sev�er TV inspected from building to se�•aer main? �Yes ❑No Condition: � Does side sewer have at least 1%slope(rom lfie building tb s�wer main? �Yes ❑Uo Oescribe: Have all building sevier drain connections to the side sevrer heen idenfified and located? �Yes ❑ No . Have all properiy slorm tlralnage connechons to the side se�ver been identified and lorated? �Yes ❑ No ; Has property been evaluatetl for drainage deliciencies�vitli findings communicated to property ou�ner? �j)Yes ❑ No � ; Inslallation Details: � ��1 � lNhai type and brand of 6WD�vas insfalled al lhis sile Clean Che�;�BINV,Grinder um , e .): � ; VJhere�vas fhe device installed(general description, atlac i map)? _ N i Was Ihere any other sewer or s�orm drainage woric completed in conjunction�vith the 81ND work? Is so please describe: � � i Installation Checklist: I Are ail downspouls and site drainage discomiected from upstream of ihe BWD7 �, Yes ❑No Commenis: i Daes BWD positioning meels minimum slope requiremenl o(>t%? �Yes [_] No Commenls � Can BWD be pulled out ior inspection and maintenance afler loosening thumb screw? �Yes ❑No ; Is BLVD locked inio Ihe proper position and thu screiv tighlened? �'Yes ❑ Ido • � Circle thz BWD cover: irr(gation cover andscape area /lrafiic load bearing cover(drive surface)I access halch(building) ! VVas propedy owner shoivn the locafion �is alled 8WD? �Yes ❑ No Comments: I Property O�xner's Signature: Date: ��I��"� I �nstaller's Signature:`�, `'�p.��:,U�-P/ Dale: '� � 6�-,�-��9� "; Revision: 2 1 Nonday,September 15, 2U1� � ;