Laserfiche WebLink
�r��2��`� �� 6�6�����`�9��R ��l�8�� �'&4�1�,�. <br />�€� E9�����&�C?a`�@��I ������.8�� <br />, �. �. —_ . _ ..�..�._...�.�.-- —�,�� <br />instaliation Company Name and Contact Info: �UP�/� ��yr,h;:�,� �{'�� <br />Da'e Back�vater Prevenlion device (BWD) was insfalled: 5"' �`( -�.S"- � pale this form vaas completed: �� � y-�T <br />Insiallafion Property OvJner 0.�ame and Contact Inio: �`'��% �' SC ��'��� ✓ `f v�� 3 4y �? 2� <br />Properly Address _,� � I� iZe rvu-✓ ��`c— <br />Nre•Installation Inspection Checkilsf: <br />Alf items must 6e checiced 'Yes' in order for a BWD fo be considered for instaflation <br />Is there a basemen; or level o( the housz ihat is at or near assumetl sewer main elevationl jRJ Yes ❑ �o <br />Are Ihere fixtures in the house locaied belo�v ihe upsUeam sewer manhole rim elevation7 0 Yes ❑ �o <br />(s the side se�ver currently UNPROT[CTFD irom sevrer backups (does not have a BIND insialled)? �I�Yes ❑ No <br />Sifo (nspeciion Ghecklist: <br />A!1 items must 6e cheched 'Ye:.' be�ore inspection !s considered compiete <br />UVas side seU�sr N inspected from building to sav�er main? �Yes ❑ Wo Condi4on: `�JG lLew <br />Does side sewer hat�e af least 1"/o slope from the building to set��er main? [� Yes ❑ No Descri6e: <br />Have all building sevaer drain connections to ihe side sower been identified and located? �cj Yes ❑ No <br />Have all property storn drainage connections to the side sem�er been Identifietl and localed? � Yes ❑ No <br />Has property been evaluated for drainage deficiencies with findings communicated to propedy ov�ner7 Q Yes �j hlo <br />ins(allaiion Jetails: <br />VUhat iype and trund of 8WD was insfalled at Uiis site (Clean Check Bl4�V, Grinder pump, etc.): ����-*� c�� Y <br />�Nhere was ihe dovice Insialled (general descripGon, atiach map)? �� JF Si �-� d� 1.;,,N.� <br />4 � � � � _ ..�..,�______ _-_ <br />�Nas lhere any other seweror storm drainage work completed in conjunclion �vith ihe BWD ti��ork? Is so please describe: _ <br />Installafion Checldlst; <br />Are all downspouM and siie drainagc disconnected irom upstream of 1he BWD? �J Yes (] No Comments: <br />Daes BWD positioning meets minimum slope requirement of >1°l0? �fj Ves ❑ h�o Commen(s: <br />Can BW[1 be pulled out for Inspeclion antl maintenance aRer loosening thumh screw? � Yes ❑ Ro <br />Is BVt�D lodced into ihe proper positlon and fhumb screw tightened? � Yes ❑ No <br />Circle fhe 6ln�D cover. rriqation r,ovef�(landscape area) ! traific load bearing cover (drive surface} I access hatch (i�uilding) <br />Was propeiiy ov,mer shown the loralion of ihe installed BWD7 � Yes ❑ No Comments: <br />Property Owner's Signatura: Date: <br />Insfaller's Signature: ���� - �`_ '�----- Dafe: �— � `I —/.S� <br />Revision: 2 1 Monday, September 15, 2014 <br />