Laserfiche WebLink
E����i�A`�'�� PR��LN�°E�k� @��l���� F!�➢�L <br />86�4�T���,��i�� �i-E�C�Q�i��' <br />Installation Company Name and Contacl Info: /� <br />Date Bacinvaler Prevenlion devir.e (BWD) was instailed: y- ��-� f Date this form ���as completetl: �/ - 2'� -( S� <br />Installation Prope�iy Ov,�ner Namo and Con(act Info: S�-�, �,. y I c:/ K�� s l� �.' �%1 <br />Property Address: <br />c� � v � rcp,',� r <br />Pre•Instailation Inspection ChecklisL <br />All ilenrs must be checkad '1'es'rn order (o� a BWD to 6e cnnsidered (or installalion <br />Is there a basemenl or level of the house fhat is al or near assumed sewer main elevation7 � Yes ❑ No <br />Are there fixtures in the iiouse locatetl below ihe upsiream sewer menhole rim ele��alion7 � Yes ❑ No <br />Is the side sev,er currenUy UNPROTECTED from sevrer bacRups (does not have a BWD insfalletl)? � Yes ❑ No <br />Site Inspection Checklist: <br />All items must be checked 'Yes' 6e(ora inspection is consldered complete <br />INas side sev�er TV inspe�ted irom building to setver maln7 [] Yes � No Condilion: �C � <br />Does side sea�er have al leasl 1% slope from the building to sev�ar main7 �Yes ❑ No Describe: _ <br />Have all �uilding sowor drain connections to ihe side seaer been idenGfiod and located? �Yos ❑ Ido <br />Have ail properiy slorm drainage connections to the side sevder 6een identified and located7 �1'es ❑ No <br />Has pmperly beon evaluated for drainage deficiencies �vilh 6ndings communicaled lo property otivner? � Yes ❑ fJo <br />Installaticn Details: <br />1Nhai type ai�� urand of 8WD �vas inslalled al Ihis sile (Clean Ched� BWV, Grinder pump, elc.): �w� �-1 ������ (rw,.. � <br />lNhere �:�as Ihe device inslalled (general desc�iption, allach �nap)7 �S/ e��.-�.+� h. C�',� ��i _ <br />41�as there any other sevrer or sloi.n drainac�e work compleletl in wnjunclion wilh the BUVD work7 Is so please descdbe: ` <br />�1//%� <br />Installa[ion Checklist: <br />Are all dotvnspouls and siie drainage disc�nnecled from upslream of the BWD? (k'�Yes ❑ No Comments: <br />C1oes BWD posftloning meots minimum slope requirement ot >1%? �] Yes ❑ No Cotrmenls: <br />Can BWD be pulled oul for Inspeclion and maintenance after loosening Ihumb scre��i7 ❑ Yes ❑ No <br />Is 8WD lor.ked into ihe proper position antl ihumb screl�r lightened? ❑ Yes ❑ No <br />Circl� the BWD cover. irngation cover (lantlscape area) I ireffc load bearing cover (drive surface)1 access hatch (building��f <br />Wa� property olvner shown Ihe lor.alion of Iho installed �WD? �] Yes ❑ �o Commenis: ,. <br />Property O�vner's Signature: Date: _.__ <br />Inslallor's Signalure: �� ,� /?'r�--- Date: y - �h,�-� � <br />Revision: 7 1 Monday, Sr.ptr.mber 15, 2014 <br />