Laserfiche WebLink
� <br />� <br />BACKWATER PREVENTION DEVICE FINAL <br />INSTALLATION CHECKLIST <br />Installa6on Company Name and Contact Info:/�75dµ�1�l��`'tA✓K�� �'��! /6�' y19� <br />Dale Backerater Prevenlion device (BWD) was installed: -��' ��/-� <br />Ins!ailation Property Ovrner Name and Contaci Inio: <br />Property Address: <br />AvE <br />this form v�as completed: "��` ���5 <br />y�,S �ll�- <br />Pre•Installation Inspection Checklist: <br />All items must be checked 'Yes' in order for a BWD to 6e considered ror inslallation <br />Is th2re a basement or level oi the house that is at or near assumed se��✓er main elevation? Yes ❑ No <br />Are there flxtures in the house lo�ated b�low the upstream sewer ma�hole rim elevation? U Yes ❑ o <br />Is the side se�ver currently UNPROTE�;TED (rom sewer backups (does not have a BWD inslalled)? �es ❑ No <br />Site inspection Checklist: <br />All items must 62 checked 'Ves' before rnspection is considered qomplete <br />Was side se�ver TV inspected irom building to sewer main? �� Yes ❑ No Condition: <br />Does side seH�er have at least i% slope from tli� building to sevr2r main? � Yes ❑ No escribe: _ <br />Have all building se+��ar drain connections to the side sewer been idenlified and located? �Yes [ No <br />Have all property storm drainzge connections io lhe side sevrer bzen identified and located? [� Yes ❑ No <br />Has property been evaluaied for drainage deficiencies ��ith findings communicated to property owner? � Yes ❑ No <br />Installation Details: P,,� <br />�Vhat type and brand of BWD tvas installetl at lhis site Clean Cher. � 14N, Grinder pIump, elc.): I'�- �� <br />Where �vas the device installed (general descripiio� attach map .�'�� S��e. � oti5e��'Jc4�i /��qu1p,� <br />Was there any other sewer or storm drainage work completed in conjunction �vilh the BVJD tvork? Is so please descrit�e: �J� <br />Installation Checklist: <br />Are all downspouts and site drainage disconnected from upstream of Ih 8WD? [�Yes ❑ No Commenls: <br />Does BWD positianing meets minimum slope requirement of >7°�6? Yes ❑ No Ca ments: <br />Can BWD be pulied out for inspection and maintenance after loosening t umb screv�? [�Yes ❑ No <br />Is BWD locked into the proper positi umb screw lighlened? �Yes ❑ No <br />Circle the BWD cover imgation cover (landscapa area I traffic I� bearing wver (drive surface) ! access hatch (building) <br />Was property owner shotivn the locafion of the inslailed BWD? Yes ❑ No Comments: <br />PropeRyOwner'sSignat re: ' \ Date: �'ZZ`��S <br />installers Signature: ����1-�-- � Date: � 7a-�'�l� <br />Revision: 2 <br />Monday, Septemher 15, 2014 <br />