Laserfiche WebLink
� BA�CKWATER PFtEVENTION DEVICE FINAL <br />INSTALLATION CHECKLIST <br />Inslallztion Company Name an� Contact Info: _.,Q r�� f� �LL! � ��- i�1� S_��L�(-, . � i�; (, <br />l <br />Date Oackwater Prevention device (BWD) �vas installed: Date this form v✓as completed �,'��/ -/� <br />n <br />Installation Property Oeener Name and Conta�t Info: �.1; (�-„ ��� /-i ;;. ;���t• �(-ZS- L�s, -/ Cs�.+�- <br />Proper�yAddress l i:Z�''1 ;��i;��ir�-�p.5�_^G!i''yY+(�GLI�� �S?�.l <br />Pre•Installation Inspection Checklist: <br />F+II items mcsf be checked 'Yes' in order `or a BWD to be consrdered (or. installaticn <br />I <br />Is there z basement or level of the house that is al or near assumed sevier main elevation? ( �es ❑ No <br />/�re chere fixtures in the house located belo�.v the upstream sewer manhole rim elevation? [��.Yes ❑ No <br />!s Uie side se�:�2r currenlly U�PROTECTED irom sewer bactups (do=s not have a B1�VD install�d)?,� Yes ❑ No <br />Site Inspection Checklist; I <br />l.�l items must be checkea 'Yes' be(ore inspection is consideied compiere <br />1%�'as side sevrer N inspected irom building to sev,�er main? I,j�Yes � No Condition: <br />Dces side sewer have al least 'I % slope from the building to setver main? (j� Yes ❑ No Descrire <br />Have all f�uildmg sewer drain connections ro!ne side se�ver been identified and located? �Yes ❑ No <br />Have aii property storm drainage connections to the side sewer been idenfified and Iocated? [ Yes ❑ No <br />Nas pruperty be�n evaluated for drainage deticiencies titi�ith findings communicated to property o��vner� j�Yes ❑ No <br />Installation Details: <br />4'Jhat typ� and brand of [3WD :vas instailed at Ihis site (Clean Check BW;V, Grinder pumo, etc.): C�ec�,. /,��,�• <br />NlherF �vas ihe device installed (general descriplion, altach map)7 _ h«�4.rc�- �r�f'� i�s i- c, �..�,.- <br />o� �n..-,�. c,> <br />1Vas Ihere any olher sewer or s,orm drainage work comoleled in conjunclion �vithi lhe [3WD �vork? Is so elease descr�be: � c7 <br />Installation Checklist: <br />Are ,,II downspouls and site drainaae disconnecled (rom upstream of Ihe 44VD? � Yes ❑ No Comments <br />Dnes B�ND positioning meets minimum slope requiremenl ol >140� � �Ycs ❑ No <br />Can BIND be pulled out (or inspe�tion and maintenance alter loesening thumb screw? <br />Is BN'� locked into ihe proper position and thumb serew tightened^ [�;Yes ❑ No <br />Commenls <br />(�'Yes ❑ ��b <br />Circle ihe BWD cover. irrigalion cover (landscape area) I Iraffic load beanng cover (drive surface) / access ha(ch (bu�lding) <br />Was property o�vner sho�vn Ihe locatien of the in� �Iled BIND? �� Yes � � No Commenls: <br />n . � <br />Property Owner's Signafure� <br />Irtstailer;s�Sign_al`ure: � <br />Vr- r � <br />Dafe: S`- ' - ! � ._— <br />to'� S •� y - i5 <br />'L� - <br />Ilewsion�. 2 1 I � Ivionday, September 15, 2014 <br />