Laserfiche WebLink
BACKWATER PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> � � �� ���� y�"-ylq� <br /> Installation Comp�ny Name and Contact Into��t�P�d�141�'�t'�yC'1L <br /> Date Backwater Prevenlion device(BWD)vlas inslalled:Ir�-1�"�l� Date this form was completed:Io�`�8^��/� <br /> Inslallation Property Owner Name and Contact Info:l�lC�ae�MblS uP� ��S�q'��31/t� <br /> PropertyAtldress:�i�`I �C�1/210�'P _ <br /> Pre•Installation Inspection Checklist: <br /> All items must 6e checked'Yes'in order for a BWD to be considered for installation I <br /> Is lhere a basement or level of the house that is at or near assumed sewer main elevation7�Yes ❑ No <br /> i <br /> Are lhere fixtures in ihe house located below Ihe upstream se�ver manhole rim elevation?�Yes ❑ho ' <br /> Is the side sewer currently UNPROTECTED from sewer 6ackups (does not have a BWD installed)? �Yes ❑ No <br /> Site Inspection Checklist: <br /> All items must be checked'Yes'before inspection is considered compiete i <br /> Was side se�ver TV inspected from building to se�ver main? �Yes ❑No Condition: I <br /> Does side sewer have at leasl 1%slope irom the building to sewer main? �Yes ❑ No Describe: _ E <br /> Have all building sewer drain connections to the side sewer been idenlified and Iocated? �]Yes ❑ No c, <br /> Have all propedy storm drainage comieclions to the side sewer been identified and located? �Yes ❑ No �' <br /> Has property been evaluated for drainage deficiencies��ith findings communicated lo properfy o�vneR � Yes ❑No � <br /> Installation Details: j�� � <br /> What type and brand of BWD was installed at this sile(Clean Check BWV,Gnnder pump, tc.): 1�-C' ��Kl ���� ��''�; <br /> Where was(he device installed(generai descriplion, attach map)? ��a� � <br /> r <br /> Was Ihere any other sewer or slorm drainage work completed in conjunction wilh ihe BWD u�ork? Is so please describe:�O � <br /> _ , <br /> Instailation Checklist: I <br /> Are all downspouls and site drainage disconnected from upstream of the 81ND? �]Yes ❑No Commenis: � <br /> Does BWD positioning meets minimum siape requirement of>1%? �Yes ❑�o Comments: <br /> Can BWD be pulled or`for inspection and maintenance after loosening thumb screw? �Yes ❑No <br /> Is BIND locked into ihe p�oper osifion and ihumb scre�v tightened? [�Yes ❑No <br /> Circle the BWD cover rrigalion cover Qandscape ar I traftic load bearing cover(drive sudace)!access hatch (building) <br /> Was property ovaner shown(he location of the installed BWD? �Yes ❑No Commenls: <br /> Property Owner's Sign ture: _ Dale� <br /> Installer's Signalure:� 11JWiU1 /� _ Date: I�-'��'%�B�T <br /> Revision: 2 1 Monday,September 15,2014 I <br /> I <br />