Laserfiche WebLink
i <br /> �ACK�AO�►�ER PRE�EN�ION ��VOCE �INe�� ' <br /> 11V�T/AL��►TIO�I Ci�ECKLOST <br /> ; <br /> , <br /> InsfallaGon Company Name and Contad Inio: e4 A- Plvn���iri c. � Z. - <l �'-v/Z.�; • <br /> Date Ba�kwater PrevenGon device(BWD)was inslalled:y-�4-/ Date ihis form was completed:�-30--/ S� � <br /> Ins[allation Property Ovmer Name and Conta�t Into: �T/�'12 /�Ltti�'� a�`�' S Z �/ i <br /> � <br /> PropertyAddress: JS� � li���.e-��-C-v' /.�'1�' i <br /> �re-installation[nspeclion Che;klist: <br /> Afl items musf be checked 'Yes'in o�der for a BWD to 6�cronsideret!for instaflafion � <br /> Is thara a basement or level of the hause ihat is at or near assumed sewer main eleva6on? es ❑Mo <br /> Are fhere fixtures in tfie house located below the upsUeam sewer manhole dm elevation? �.�-N�s ��]No � <br /> Is the side sewer currenUy UNPRO7ECTED from sewer backups(does not have a BWD installed)?[kJ-Yct ❑No ( <br /> Site lnspectfon Chw:Ylist: � <br /> Ati'dems must be chec�ce�'Yes'belere inspection is consrdered compfete � <br /> VVss side sewer N inspected bom huilding to sewer main� [t�-YEss ❑No ;:ondition: �7�' °��� i <br /> Daes side sewer have a[least 1%slope from Ihe 6uilding fo sevrer main? �� ❑No Describe: ' <br /> Have all 6uilding sewe•drain connecfions lo Ihe side sewer been idenlified and located? �-1`ES ❑No <br /> Have all pmperry stortn drainage connaclions to the side sewer been idenOfied and located7 [�.1'es ❑No <br /> Has property been evaluated for drainage deficiencies with findings wmmueicated to pioped;owner? Q.Yss ❑No <br /> i <br /> insQall�tfon Details: �,/� <br /> �Nhat rype arni brand ot BWD lvas installed al lhis sAe(Clean Check BINV,Grinder pump,etc.): C�C a.<-l-'�-�Cl�. • <br /> i <br /> Whe�e was Ihe device inslalled (generel descnption,attach map)? �e i►�� • i <br /> i <br /> � <br /> VNas there any other sev�er or slorm drainags work cnmpleted in conjuncfion u�ilh Ihe BWD a�ork? is so please describe:_ � <br /> I�stallation Checklisk � <br /> Are ali downspout�and sile drainage disconnecled from upstream of the BUJD? es ❑No Commenls: i <br /> Daes BWD positioning maels minimum slope requirement o(>1%? Q� ❑Mo Comments:_ ; <br /> Cen BWD be pulled aut for inspection and maintenance aRer loosening lhumb s�re�v? [�'es ❑No <br /> Is BWD locked inlo the proper posilion and lhumb scre�v Ughtened7 �s ❑No ; <br /> � <br /> Circle fhe BWD�ver: irtiga6on cov landscape area raifi:load bearing cover(drive su�(ace)/access hatch (building) j <br /> Was property owner shown the localion of lhe installed BVUD7 ��s ❑No Commenis: � <br /> PropeAy Owner's Signatu� � �^"�-- oate: ��� �1 ��S� ' <br /> InSha(ler's Signal�re: . � Dale:Lj l� �� j <br /> i <br />� Revislon:2 1 Friday,Septemher 12,2014 � <br /> i. <br /> I <br />