Laserfiche WebLink
BACKWATER PREVENTION DEVICE FINAL <br />{NSTALLATION CHECKLIST <br />Installa6on Company Name and Contact Inio: �fo//G ��u� �� � c <br />Date Backwater Preven6on device (BWD) was inslalled: Date this iortn was wmpieted: <br />Installation Property O�mer Name and Conlact In(o: ,�//i�- �sS <br />PropertyAddress: ��6 V ��,�n.� �1V / – - <br />Pre�lnstallation InspecUon Checklist: <br />All rtems must be checked'Yes' in order lor a BWD to be considered /or insfalialton <br />Is �here a basement or level of the house lhal is at or near assumed sewer main elevation? 0 Yes ❑ No <br />Are there Gxlures in the house localed belov+the upstream sewer manhole rim elevation? ❑ Yes ❑ No <br />Is ihe side sewer currently UUPROTECTED from sewer backups (dxs nol have a BWD inslalled)7 � Yes ❑ No <br />Site Inspection Checklist: <br />All ifems must be checked'Yes' before inspectron is considered complete <br />Was side sewer N inspected from building to sewer ma!�? [� Yes ❑ No Condition: <br />Does side sewer have at least 1% slope (rom the bullding to sewer main? ❑ Yes ❑ No Describe: <br />Have all building sewer drain connectlons to Ihe side sewer been iden6fied and locateu? ❑ Yes ❑ No <br />Have ail property storm dr�inage conne�tio;�s to lhe side se�ver been idenlified and located? ❑ Yes ❑ No <br />Has property been evaluated for drainage deficiencies wilh indings wmmunicaled to property owne� 7❑ Yes ❑ No <br />Installatlon Details: <br />What type and brend o( BWD w�as installed at lhis siie (Clean Check BWV, Grinder pump, etc.): <br />Where was lhe device installed (general descriplion, attach mapj7 <br />Was lhere any other sewer or sto�n drainage work eompleted in conjunction with the B�VD wodc? Is so please describe: _ <br />Installation Checklist: <br />Are all downspouls and site drainage disconnected from upslream o1 lhe BWD? ❑ Yes ❑ No Commenis: <br />Dces BWD posiGaning meets minimum slope requirement of >1%7 ❑ Yes ❑ No Comments: <br />Can BWD be pulled oul for inspecfion and mainlenance afler loosening lhumh screw? ❑ Yes ❑ No <br />i� awn i„�kPd i�to �he nraner oosilion and thumb saew �yh�ened? ❑ Yes ❑ No <br />Circle the BWD cover. irrigaVon caver (landscape area) I traRc load bearing cover (drive surlace) I access hatch (building) <br />Was property owner shown the localion of th ' stalled BWD7 ❑ Yes ❑ No Commenls: <br />Property0wnersSignatu • ��— pate: Z Z� r`' <br />Inslallcr'sSi�naWr Date: ���/ /� <br />Revision: 2 <br />Friday, Septem6er 12, 2014 <br />