Laserfiche WebLink
i <br /> � BACKWATER PREVENTION DEVICE FINAL � <br /> INSTALLATION CHECKLIST <br /> , <br /> � <br /> Inslallation Company Name and Contact Info: .J�+�'1 P�'j�11�S 1"�-V�1�fS I�l(� l.l�% ( : I <br /> 'T <br /> Date Back�vaterl�revenlion device(�WD)was insfalled: �'� �' �� Date lhis form was compleied: ��''�'�.S_ <br /> Installation Property Owner Name and Contact Info: Q�,l�}�� <br /> Pra erty Address: 1�. l33/ �'u c%ar ,f�d�- ��er.�--F� G' `�fr�-e'� � <br /> . p <br /> I <br /> Pre•Installation Inspection Checklist: <br /> All items musl be checked'Yes'in o,der for a BV�D to be considered(or installation <br /> Is there a basemenl or level of ihe house that is at or near assumed se�cer main elevation?���� es ❑No <br /> Are thcre fizlures in the house located below the uost�eam se�ver manhole rim elevation9�i Yes ❑�N�o <br /> Is Ihe side soti�,er curremly UNPROTECTED from sewer backups (does nol have a BN�D installed)?G�''Yes ❑ No <br /> Site Inspection Checklist: <br /> �II ilems must be checked'Yes'before inspection is considered complefe <br /> �Vas side sewer N inspected(rom building to se�ver main? u Yes ❑ No Condilion I <br /> Docs side sewer have at least 1%slope.(rom the building to se�ver main? []Yes ❑No Desc�ibe. <br /> Have ail buildiny sewer drain connections to lh� side sewer been identifed and located? [�Yes [] �Jo � <br /> Have all property sform drainage conneclions lo the side sewer been identified and located? [�es ❑No � <br /> Hzs properiy beei�evaluated (or drainage deficiencies with findings communic�!�d to property owner? ��Yes ❑No � <br /> Installation Details: <br /> 4Vhal type and hrand oi(�WD was installed at Ihis site(Gean Gheck BNN, Gnnder pump,etc.):��irss �,,Q1� <br /> r <br /> Where.e+as the devicc instaVed (general description, attar,h map)? k,�k o/� �,.s�•.,i�� a».� _ <br /> �� ' •- 6hfy-O <br /> 0�vF' -I-l�¢. �u.-�1.t��,o� A'rSP�tn1ED <br /> Was Ihere any oiher se�ver or sbrm drainage ,vork completed in conjunclion v+itn Ihe BWD�vork? Is so please descri6e: eS <br /> , / p�' " - � <br /> �'QwCw 1v:�5' .L.kr1,-.tc� _ l�/ e�.�rnR.�VSr�s t!Y'CaVG.-�•+ ��lA' vv�Go.c �!J G�¢�� i <br /> J' --�___ � ` � <br /> Inslallation Checklist: <br /> Are all dov, ..cpouls and site draina,ye disconr�cled from upstream nt lhe 8 D� [�Yes �_� No Commenls:______ <br /> Does��1'D posilioning meefs minimum slope requirement o(>t%? [ es ❑No C�o/mmenis: ___ <br /> Can BWD 6e pulled out(or inspeclion antl maintenance a((er loosening lhumb scre�v7 [✓1 Yes ❑No <br /> Is B4VD locketl inln ihr. proper position and lhumh screw tightened? �es ❑ No <br /> Cirde the BN'D crover i � ' ���. t�, �,� � ri e s � � '�tt�) ` <br /> Sr�v✓' . I <br /> VJas property owner shown lhe location o(the insl�dled 814�D? ��s ❑ No Commenls: � <br /> Properl5�Owner's 5ignature __-� 4 G�--� �•'- ___ Date: ZS ���� /s _ � <br /> Installer's Signature:��uf-tir�_� _ _ __,_ Date:_2- 7�'^i5 _ <br /> � <br /> Revision�. 2 1. Monday, September 15, 2014 <br />