Laserfiche WebLink
BACKWATER PREVENTION DEVICE FINAL <br />INSTALLATION CHECKLIST <br />Lt <br />Installation Company Name and Contact Info: A <br />Date Backwater Prevention device (BWD) was installed: L� LZ Date this form was completed: t l% <br />Installation Property Owner Name and Contact Info: <br />Property Address: <br />Pre -Installation Inspection Checklist: <br />All items must be checked 'Yes' in order for a BWD to be considered for installation <br />Is there abasement or level of the house that is at or near assumed sewer main elevation? [g Yes ❑ No <br />Are there fixtures in the house located below the ,astream sewer manhole rim elevation? P Yes ❑ No <br />Is the side sewer currently UNPROTECTED frc . 3wer backups (does not have a BWD installed)? [Yes ❑ No <br />Site Inspection Checklist: <br />All items must be checked 'Yee' before inspection is considered complete <br />Was side sewer TV inspected from building to sewer main? Z,Yes ❑ No Condition: <br />Does side sewer have at least 1%slope from the building to sewer main? '1�7l Yes ❑ No Describe: <br />Have all building sewer drain connections to the side sewer been identified and located? J4Yes ❑ No <br />Have all property storm drainage connections to the side sewer been identified and located? $n Yes ❑ No <br />Has property been evaluated for drainage deficiencies with findings communicated to property owner? P Yes ❑ No <br />Installation Details: pump, etc.): ) �ti( t<) <br />What type and brand of BWD was installed at this site (Clean Check BM, Grinder : r <br />Where was the device installed (general description, attach map)? <br />R�ri%1� <br />— '' <br />Was there any other sewer or storm drainage work completed in conjunction with the BWD work? Is so please describe: _ <br />A[U•Yl_P <br />Installation Checklist: <br />Are all downspouts and site drainage disconnected from upstream of the BWD? R Yes ❑ No Comments: <br />Does BWD positioning meets minimum slope requirement of>t%? jg Yes [—]No Comments: <br />Can BWD be pulled out for inspection and maintenance after loosening thumb screw? 0 Yes ❑ No <br />Is BWD locked into the proper position and thumb screw, tightened? (Yes ❑ No <br />Circle the BWD cover: irrigation cover (landscape area) I traffic load bearing cow r (drive surt� access hatch (building) <br />Was property owner shown the location of the installed BWD? Yes ❑ No Comments: <br />Property Owner's Signature: Date: <br />Installer's Signature: Date: �? <br />Revision: 2 1 Friday, September 12, 2014 <br />