Laserfiche WebLink
� <br /> BACKWATER PREVENTION DEVICE FINAL i <br /> INSTALLATION CHECKLIST � <br /> , <br /> � <br /> �� <br /> Installation Company Name and Contact Inio: }�; ���'� '� � `� �� � <br /> Date Bacl�tivater PravenGon device(BVJD)�vas installed: �� �S Date this form was completed: S � s � �` <br /> Installation Propedy Ovmer hame and ConLct Info:L ti���1-� I n��� �� �� � <br /> Proper�yAddress; �-3 ,`^.f- S�' � <br /> Pre-Installation Inspection Checklist: � <br /> i <br /> Al!item:must be chec�;ed'Yas'ir order`or a 8l'✓D to be considered/or ir,stalla5on i <br /> Is there a basemect or!evel of th�house tnat is at or near 2ssumed sewer main elevationl[�j Yes ❑ No i <br /> Are there fixtures in the house locatzd belo:v the upstream sew2r manhole rim efevaiion?(�Yes ❑No . <br /> Is the side se��,er currently UNPROTECTED from se:ver backups {dees not have 2 B:ND installed)9�.J Yes ❑ No <br /> Site Inspectian Checklist: , <br /> Ali items must 6e checkea`Yes'before insp=ction is considered crompl°fe : <br /> Was side seu�er N inspected from building to sewer main? [�Yes ❑ No Condifion: f <br /> 6oes side se�var have at least 190 siope from ti�e building to se:ver main7 I�Yes ❑No Describe:_,� � <br /> Have all building se�aer drair connections to the side sevrer 6e2n identified and located? �Yes ❑ho i <br /> Have ail propeRy storm dr2fnage connections to ihe side sev,�er been identified and!oc2ted. m Yes ❑�o <br /> Hzs property been eealuated for drainage deficiencies wiih fndiogs communicated to properY�oaner? �]Yes ❑ No i <br /> InstallaUon Details: � <br /> 4Vhat type and brand of B1�FD�:�as installed at lhis sile�Clean Che�rinder pump,etcJ:_ � <br /> Where v:as the devlce insta11ed(general description,zttach map)? ��r �.<<r �� ��°�' '�" r`•`"''.` I i <br /> ----�nT /� <br /> T L4'� I /l�� Il - � <br /> lNas lhere any oth=r see;er or storm drainage work completed in conjunction wi!h fhe BV��D��;ork? Is so please descnbe:_. ; <br /> ��v j <br /> Installation Chocklist � <br /> Are all do�ti�nspouts and site drainage disconnecfed from upstream of the BWD7 �Yes ❑ No CommeMs: � <br /> Does BWD positioning meets minimum slope requirement of>1°'0? �Yes ❑ No Comments: � <br /> Can BWD be pulled out for inspe�lion and maintenance after loosening thumb scre�v? �Yes ❑No ; <br /> Is BSND locked into the rope�po:itiorran cre�v tlyhtened9 [�Yes ❑ No i <br /> Circle the BWD c�v : irigation cover(landscape area) tra�c load bearing�over(drive suriace}!access hatch(bufiding) � <br /> Was property owner shown ihe ocabon o t e installed BWD7 rf.]Yes ❑No Comments: ! <br /> � j <br /> Property Owner's 5ignature; Date: ` <br /> Installers Signature: Date: � " ` r' � 5 ; <br /> � � . <br /> Revision:2 — � �/ 1 Friday,Septem6er 12,2014 <br />