Laserfiche WebLink
BACKWATER PREVENTION DEVICE FINAL <br /> li�'.STALLATION CHECKLIST <br /> Installation Company Name and Contact Info: aa-'�� P/u�<Z�f s ft[�7 3�fJ >5�7 I <br /> !, <br /> Dale Backwater Prevention device(BWD)was installed: 1�/�/�s Date this torm was completed:_ � / �s ! <br /> � <br /> Installation Property Owner Name and Contact Info:A �i�c � , � <br /> ' <br /> � <br /> PropedyAddress: '� -� fLNck�/ f{�� -- <br /> Pre-Installation Inspection Checklist: <br /> All items must be checked'Yes'in order for a BWD to be considered(or installation <br /> Is there a basement or level of the house lhat is at or near assumed sewer main elevalion?�Yes ❑No I <br /> Are there fixtures in the house lacaled helow lhe upsiream sewer manhole rim elevation?(�]Yes ❑No � <br /> i <br /> is the side sewer currently UNPROTECTED from sewer backups(does not have a BWD installed)?�Yes ❑No <br /> Site Inspection Checklist: <br /> Ail items must be checked'Yes'before inspection is considered complete <br /> Was side sewer N inspecled from building to sewer main7 �Yes ❑No Condition: <br /> Does side sewer have at leasl 1%slope from lhe buildi�g to sewer main? �Yes ❑No Descri6e: <br /> Have all buiiding sewer drain connections to the side sewer been identified and located? (�Yes ❑No ; <br /> Have all properly storm draioage connections to the side sewer been identified and located? �Yes ❑No � <br /> Has property been evaluated for drainage deficiencies wifh findings communicaled to property owne� �Yes ❑No <br /> Installation Details: <br /> What type and 6rand of BWD was installed at lhis s' ean Check BWV rinder pump,ctc.): <br /> Where was the device installed(general description,aflach map)? D���e �+o,��GG� � r��T <br /> c i9D t o �ti s" t7t' G� 17�i Ve,wu`/ - <br /> Was ihere any olher sewer or storm drainage work compleled in conjunction with the BWD work?Is so please describe:_ y <br /> /✓d �� <br /> 1 <br /> Ins'allation Checklist: � <br /> Are all downspouts and sile drainage disconnecled from upstream of the BWD? �Yes ❑No Commenls: ! <br /> � <br /> Does BWD posilioning meels minimum siope requirement ot>1%? �Yes ❑ No Commenls: <br /> Can BWD be pulled out tor inspection and mainlenance after loosening ihumb screw? ,�Yes �]No <br /> Is BWD locked inlo the proper positio i htened? �Yes ❑No <br /> Circle the BWD cover.i ' ation c er(landscape area�t��ic load bearing cover(drive surface)I access hatch(building) <br /> 4Vas property owner shown the oca ion of ih installed BWD? �Yes ❑No Comments: �i�sc�<i I . n� <br /> Property0�mersSigna re: � Uate: � ^ S —( s , <br /> Installcrs Signatur - <br /> "� Dale: I�S//S I� <br /> Revision:2 1 Friday,September 12,2014 <br /> di <br /> VI <br />