Laserfiche WebLink
I <br /> � <br /> f3A�CKWATER PRE:VEN jiON DEVlCE FWAL <br /> INSTALLATION CHECK!IST <br /> � I <br /> Inslallalion Company Name and Ccntact Infa ,�r�� r`' �LL'S' �L���1�i5 in�(, � I. <br /> i <br /> Dale f3ackwaler Prevenlion device(dIND)was installed:_�o ���I� Date this form�as �ompieied: � �s 4��/5 <br /> Inslallaiion Property Owner Name and Contact Info: f� C'� � � � <br /> (� R.-���LC'�C�E� l� , <br /> PropertyAddress. _�f_32 V�vc1c�� l� � � ��������2�I � <br /> Pre•Installation Inspection Checklist: � <br /> :iil irems musf be r,hecked 'Yes'in order lor a RIND to 6e consiaered lo I instaflalion <br /> is there a 6asemert or level o`the house that r al or near assumed seti��er main e!evation? Yes ❑ ��o, <br /> Are fhere 6xliues in Ihe house Incated below the upslream se�rer manho!e rim e'evation7 ['�Yes ❑No <br /> Is Ihe side se�ver currenUy UNPROTECTED from seeler backups(does hol have a D14'D insla�!ed)? Ye; (] tdo <br /> Site Inspection Checklist: � <br /> All items must t�r.hecked 'Yes'be(ore inspecfion is conside�ed co te�e <br /> 'l�las side sevrer N inspected from building lo se�:�er mam? Yes '0 No r�dition: <br /> Does side se�ver have at leasl 9%slope(rom the building to sewer main�? Yes ❑ No DP cPibe: � <br /> Nave all buildma se�ver drain connections lo Ihe side sev�er been identified and localed? Yes ❑�b <br /> Have all properry storm drainage connections to the side sewer heen id�ntified and localed? [Yes ❑No <br /> Has property been evaluated tor dra;nage deficiencies with finAings com niunicated fo propert�o�vner? ;Yes ❑ No <br /> Installalion Details� I <br /> ',—�_.� <br /> 1'Jhal type and hrand ot BIND v;as installed al lhis ile(C!ean Check E3VW,�finder pump, elc,):�- ��� c/,��e <br /> lUhere�vas lhe device installed (generat descript�q.�y(�ap)? �� 0.f� <br /> I ` <br /> Was ihere any other sewer or slorm drainage work completed in con�unition with the RWD work7 Is so please describe:�1� <br /> Installation Checklist: — <br /> � <br /> Are all downspouls and silr. drainaye disconnecfed from upsiream of Ihe�BWD7 ❑ Yes No Commenls <br /> Docs l;V�'D posConing meets minimum slope requirement of>1%? �_ Yes ❑ No Comments: _;_ <br /> Can RVdD be,pulfed out for inspection and mainlr.nance atter lousening 1 umb screw? �es ❑No • <br /> Is BIND locke� iNo the proper posilion and thumb screvt tightened? Yes ❑ No <br /> Circle tlie BWD cover: i : � <br /> ���s'C�er landscape area)I Iraffic loa�ng cove!(drive surface)I ac�ess hatch(build�n9) <br /> `+'Jas property owner shown the localion of ihe installed BWD? Yes � <br /> ❑ No Commenls: , <br /> P1roperty0vrners'Signatu�e: � � <br /> �--��=� � Dale: D/S <br /> Installe�'s Signature:�1 �r S� , I �� <br /> - Dale: � <br /> Hevlsfon: 2 �i � � <br /> � �londay, Septernhe� 15. 7flla <br /> i � <br />