Laserfiche WebLink
BACKWATER PREVENTION DEVICE FINAL. <br />41-7T INSTALLATION CHECKLIST <br />Installation Company Name and Contact Info: � <br />Date Backwater Prevention device (BWD) was <br />Date this form was completed: <br />4ctyj( <br />v, 4 's —;314 -'S I <br />Installation Property Owner Name and Contact Info:'�"ri3 Yl � �_ �— <br />Property Address: <br />Pre installation Inspection Checklist: - <br />AII items must be checked 'Yes' in order for a BWD to be considered for installation <br />Is there a basement or level of the house that is at or near assumed sewer main elevation? P Yes ❑ No <br />Are there fixtures in the house located below the upstream sewer manhole rim elevation? b4Yes ❑ No <br />Is the side sewer currently UNPROTECTED from sewer backups (does not have a BWD installed)? [Yes ❑ No <br />Site Inspection Checklist: <br />All items must he checked 'Yes' before inspection is considered complete G <br />Was side sewer TV inspected from building to sewer main? RYes ❑ No Condition:__ _ <br />Does side sewer have at least 1% slope from the building to sewer main? WI Yes ❑ No Describe: <br />Have all building sewer drain connections to the side sewer been identified and located? ®Yes []No <br />Have all property storm drainage connections to the side sewer been identife: and located? N Yes ❑ No <br />Has property been evaluated for drainage deficiencies with findings communicated to property owner? VYes L] No <br />Installation Details: _ <br />What type and brand of BWD was installed at this site (Clean Check BWV, Grinder pump, etc.): PC�zr L� i� <br />Where was the device installed (general description, attach map)? t5IPP a.J[Qc toci /-1-5—&el -i- <br />Was there any other sewer or storm drainage work completed in conjunction with the BWD work? Is so please describe: _ <br />Installation Checklist: <br />Are all downspouts and site drainage disconnected from upstream of the BWD? [Yes ❑ No Comments: <br />Does BWD positioning meets minimum slope requirement of>l%? RfYes ❑ No Comments: <br />Can BWD be pulled out for inspection and maintenance after loosening thumbscrew? F Yes ❑ No <br />Is BWD locked into the proper position and thumb screw tightened? `It(J Yes (J No <br />Circle the BWD coy : irrigalio ver jandscape area) I traffic load bearing cover (drive surface) I access hatch (building) <br />Was property owner shown the location of the installed BWD? Yes ❑ No Comments: <br />Property Owner's Signature:�� c� <br />Installer's Signature: <br />Friday, September 12, 2014 <br />Revision! 2 <br />Date: /z 9 <br />Date: 4- <br />