Laserfiche WebLink
BACKWATER PREVENTION DEVICE FINAL_ <br />4wrr INSTALLATION CHECKLIST <br />Installation Company Name and Contact into: 1 r -t/06 blrZ r ry ( . <br />Date Backwater Prevention device (BWD) was installed: a ?/i S Dale this form was completed:,% <br />Installation Property Owner Name and Contact Info: /(/P! rl <br />Property Address:_ 2t8 ('uc_k�r Ave_ <br />Pre -Installation Inspection Checklist: <br />All items must be checked 'Yes' in order fore BWD to be considered for instaffation <br />Is there a basement or level of the house that is at or near assumed sewer main elevation? Vales ❑ No <br />Are there fixtures in the house located below the upstream sewer manhole rim elevation? E&Ws ❑ No <br />Is the side sewer currently UNPROTECTED from sewer backups (does not have a BWD installed)? [41 es ❑ No <br />Site Inspection Checklist: <br />All items must be checked 'Yes' before inspection is considered complete <br />Was side sewer TV inspected from building to sewer main? t es []No Co dition: <br />Does side server have at least 1 % slope from the building to sewer main? Lnles ❑ No De ribe: e � <br />Have all building sewer drain connections to the side sewer been identified and located? es No <br />Have all property storm drainage connections to the side sewer been identified and located. Yes ❑ No <br />Has property been evaluated for drainage deficiencies v4lth findings communicated to property owner? Yes ❑ No <br />Installation Details: <br />What type and brand of BWD was installed at this s e (Clean Check B1Mf, rinder pump, etc.): <br />Where was the device installed (general descripti n, attac i map ? _ A'"►Tia �`��� <br />Was there any other sewer or storm drainage work completed in conjunction with the BWD work? Is so please describe: 1`0 <br />Installation Checklist: <br />Are all downspouts and site drainage disconnected from upstream of the D? Yes ❑ No Comments: <br />Does BWD positioning meets minimum slope requirement of >i%? Yes []No Comments: _ <br />Can BWD be pulled out for inspection and maintenance after loosening lhr b screw? ❑ Yes []No <br />Is BWD locked into the proper position and thumbscrew tightened? 4yes ❑ No <br />Circle the BWD cover: irrigation cover (landscape area) I traffic load aring cover (drive surface) / access hatch (building) <br />"'as property owner shown the location of the installed BWD7 j Yes ❑ No Comments: <br />Property Owners Signature:installers Signature: <br />Date: 71/5 <br />Dale: �/-2^�/i�— <br />Revision: 2 1 Monday, September 15, 2014 <br />