Laserfiche WebLink
BACKWATER PREVENTION UEVICE FINAL <br /> INSTA�LATION CHECKLIST <br /> Installation Company Name and Contact Info:�/�o//a !�/u/r 3 J9 .3�f7 �' �5�7 <br /> Date Backwater Preventirn device(BWD)was installed: 2 G� /f Date ihis form was completed: Z Z7 �-f <br /> Installation Property Owner Name and Contact Info: rL %�-�- ��p�� <br /> PropertyAddress: �/i7 we���N <br /> Pre-Installatioa Inspection Checklist: <br /> All items must 6e checked'Yes'in order lor a BWD to be considered for installatlon <br /> Is there a basement or level of the house lhat is at or near assumed sewer main elevation?�Yes ❑No <br /> Are there fi#ures in the house localed below the upsUeam sewer manhole rim elevation?�Yes ❑No <br /> Is ihe side sewer currently UNPROTECTED from sewer backups(does not have e BW�instalied�?�1'es ❑No <br /> Site Inspectlon Checklist: <br /> All items must be checked'Yes'6e(ore inspectlon is considered compfefe <br /> Was side sewer N inspecled from building to sewer maln7 �Yes ❑No CondiHon: <br /> Does side sewer have at least 1°k slope trom the building to sewer main7 �Yes ❑No Describe: <br /> Nave all building sewer drain connettions to fhe side sewer been identified and located? �Yes ❑No <br /> Have all property storm drainaga conneclions to the side sewer been identified and located? �'Yes ❑No <br /> Has properiy been evaluated for drainaga deficienaes with findings communicated to properly ownef� �Yes ❑No � <br /> Installatlon Details: <br /> What rype and brand of BWD was installed at this site( ean Check BWV nder pump,etc.): <br /> Where was Ihe device installed(general description,attach map)? ��''P L'�/+ G✓t a. ol'� BG�� � <br /> �r U4lj <br /> Was there any other sewer or storm drainage work completed i�nJunction with the BWD work?Is so please desaibe:_ <br /> N <br /> Installation Checklist <br /> Are ali dowrspouls and site drainaga disconnected fram upstream of lhe BWD7 e]Yes ❑No Commenls: <br /> Does BWD positioning ments minimum slope rnquirement o(>1%7 �Yes ❑No Commenls: <br /> Can BWD be pulled out for inspeclion and mainlenance after loasening Ihumb sctew? �Yes ❑No <br /> Is BWD locked inlo the proper sition.and� tightened? �Yes ❑No <br /> Circle the BWD cov . rriga�on cover(landsca affic load bearing cover(drive suriace)1 access hatch(building) <br /> Was property owner shown ihc location of ihe Installed BWD1 �Yes ❑No Commenls: <br /> Property Owners Signatur • �—�1�7'�"10 r Date: �/i 9/i r� <br /> Instaliers Signatur@,✓_� �- '�~ ~ Date: 2 /i9/ /S' <br /> Revision:2 1 Friday,September 12,2014 <br />