Laserfiche WebLink
BACKWATER PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> Ci�C�'�C;r�{� <br /> Installation Company Name and Contact Info: <br /> �' �G . LGC , �; ��v� �� <br /> Date Backwater Prevention device(BWD)was installed: �� Date tfiis form was compieted: <br /> Installation Property Owner Name and Contact Into:��;� �' ����� �a�� Z�'��—� <br /> Property Address: 1�FO� fSL.C_C_" E�-C.A" '� �' `�''r`O � � �`� � <br /> Pre•Installa6on Inspection Checklist: <br /> All items must 6e checked'Yes'in order for a B WD to be considered�or installation <br /> Is there a basement or level of the house thal is at or near assumed sewer main elevation?�Yes ❑ No <br />..yr. Are there fixtures in ihe house looated below the upstream sewer manhole rim elevation7[�Yes ❑No <br /> Is the side sewer currently UNPRCTECTED from sewer backups(does not have a BWD installed)7�Yes ❑No <br /> S(te Inspecti�n Checkiist: <br /> All ifems must be checked'Yes'before insFsction is considered complete <br /> Was side sewer N inspected from 6uilding ro sewer main7 �Yes ❑No Condition: �CY� <br /> Does side sewer have at least 1%slope from the building to sewer main? �Yes ❑No Describe: <br /> Have all building sewer drain connecGons to the side sewer been identified and located7 �Yes ❑No <br /> Have ail property storm drainage connections to the side sewer been identified and located7 �Yes ❑No <br /> Has property been evaluated for drainage deficiencies wilh findings communicated to prope�ty owner7 �Yes ❑No <br /> Installation Details: <br /> What type and brand of BWD was installed at this site(Clean Check BWV,Grinder pump,etc.): F r � �. � <br /> Where was the device installed(general descriplion,attach map)7 �� C.t �'U��c-� f�:S 1� �� <br /> Was there any other sewer or storm drainage work completed in cronjunction with the BWD work?Is so please describe:_ <br /> 1��(Y1P <br /> Installatfon Checklist: <br /> Are all downspouts and site drainage disconnected from upstream oi the BWD7 �es ❑No Comments: <br /> Does BWD positionirg meets minimum slope requirement of>1%? �Yes ❑No Comments: <br /> Can BWD be pulled out for inspection and maintenance after loosening thumb screw7 �Yes ❑No <br /> Is BWD lo�ked into the proper positioo and thumb screw tightened? �Yes ❑No <br /> CirGe the BWD cov :irrigation cover ndscape area)1 traffic load bearing cover(drive suriace)/access hatch (building) <br /> Was property owner shown the location of Ihe inslalled BWD? '�Yes ❑No Comments: <br /> �Property Owner's Signature: °� � �'��-�--t- oate: �I�71/ �� Z4 /�I. , <br /> Installer s Signature: Date: = �g � <br /> Revision:2 1 Friday,September 12,2014 <br />