Laserfiche WebLink
BACKWATER PREVENTION DEVICE FINAL <br />INSTALLATION CHECKLISY <br />�C, <br />Inslallation Company N�me and Contact info: ' ' " �-�' ' `" "' : - """"' ' '" `" � <br />Date Backwater Prevention device (BNJD) was installed:�� Date this form was completed:_J,�� <br />Instellation Property (`'vner Name and Contact Info: m�/"�� n � I i�nSYl c1P. 4'ac5 - au`�' a'�1! � <br />Property Address: " " - <br />Pre•Installation Inspection Checklist: ✓ <br />All ifems must be checked 'Yes' in order for a BV✓D to 6e considered fer `nstallatio�i <br />Is ihere a basement r• ievei of the house that is al or near assumed s.ewer main elevation? �Yes ❑ No <br />Are there fi�ures in tl, iouse located below Ihe ups�ream sewer manhole rim elevation? �Yes ❑ No <br />Is the side sewer currently UNPROTECTED irom sewer backups (cioes not have a BWD installed)? [�t Yes ❑ No <br />Site Inspection Checklist: <br />All items must be checked 'Ves' before inspectron is considered complete <br />Was side sewer N inspected From buiiding to sewer main? �Yes ❑ No Condition: <br />Does side sewer have at least 1%slope irom the building to sewer main? �Yes ❑ No Describe: _ <br />Have all building sewer drain conner' > to the side sewer been identified and located? �Yes ❑ No <br />Have all property slorm drainage connections to the side sewer 6een identified and located? �"Yes ❑ No <br />Has property been evaluated for drainage deficiencies with findings cnmmunicated to property o�rmer? � Yes ❑ No <br />Installation Details: ^ /� <br />What type and brand of BWD was installed at this site (Clean Cheok BWV, Gnnder pump, elc.): 1-lP/'�c�f',�� S/ <br />Where was the device inslalled (general descriplion, attach map)? �p �'i ���� d .L� ��� <br />Was there any other sewer or storm drainage work completed in conjunction with the BWD work? Is so please describe: _ <br />Installation Cheeklist: <br />Are all downspouls and site drainage disconnected from upsir�am of the BWD? [�Yes ❑ No Comments: <br />Does BWD positioning meeis minimum slope requirement of >1%? [�Yes ❑ No Comments: <br />Can BWD be pulled out for inspeclion and maintenance after loosening thumb screw? �Yes ❑ No <br />Is BWD locked into the proper position and thum6 scretv tightened? �Yes ❑ No <br />Circle the BWO cover: irrigation cover (landscape area) I lralfic load bearing cover (drive suriace) I access hatch (building) <br />Was property owner shown the location of the installed BWD? ❑ Yes ❑ No Comments: <br />!'• C'/�12�_ Date: ��'%�-��/ <br />Property Owner's Signature; —. <br />� , <br />Installers Signature: CL- Date: �� 1(�'i.�' <br />Reviciorr. 2 1 Friday, SPotember 12, 2014 <br />