Laserfiche WebLink
�yn <br />�� <br />.� <br />� <br />�A�C�96'�A�'�6� ���@9�ti!l�0�1� ���@�� �@NAL <br />0�9�`����,��'��h� �Fi����I�Y <br />Inslallation Company Name and Coniact Info: �'�I DE/� ��tir, <br />� <br />Date BacMvater Prevention devi�e (BWD) �vas installed: � Date this form was completed: �l-f S 1 f <br />Installation Property Ovmer Name and Contact Info: Pti �. I S�: � <br />Property Address: �O 2 �'1_ _ �✓ec�i`^ort- _ � <br />Pre•Installation Inspection Checklist: <br />All items musl be ct�eclred 'Yes' in order lor a BIND to be considered for instellation <br />Is there a basement or levei o� the housc thal is at or near assumed se�ver mafn elevation? �1'es ❑ No <br />�re there nxtures in the house located beiovl Ihe upstream sewer manhole rim elevation? j�1'es ❑ No <br />Is ihe side sevrer currently UNPROTECTED (rom saeaer backups (does not have a BIND insialled)? (�'Yes �] No <br />5ite Inspection Checklist: <br />All items must be checked `Yes' before inspecfion is considered complete <br />Was side sev�er TV inspecied trom building to sevder main7 �Yes ❑ �o Condition: �rY"'� <br />Does side sewer have at leasl 1% slope from the building to sevaer main? � Yes ❑ �o Describe: <br />I-iave all building sewer drain connections to tne side sewer been idenlified and localed? � Yes ❑ No <br />Have all properiy slorm drainage conneclions to the side sswer been ident�ed and lo�ated7 �Yes ❑ No <br />Has property been evaluated for drainago da6cier,cies v,�iih findings communicated to property owner? �Yes ❑ No <br />Installation Details: <br />Whet type und brand oi [iW� �vas installed at this site (Clean Check BWV, Grinder pump, etc.)� _�� <br />1�Jhere was the device instailed (general doscriptlon, atiach map)? _ y� .._.___. <br />�Vas there any olher s2wer or slonn drainagP work completetl in wnjur�clion wdh the aWD work? Is so please descrlbe: _ <br />Installation Checltllsf: <br />F�,re all do�l�nspouls and siie drainage disconnecled irom upstream of thr, BWD? ❑ Yes ❑ No Comments: <br />Does [3WD posflioning meeis minfmum slope reqeiremenl of >1%? (] Yes ❑ �Jo Comments: <br />Can BWD be pulleci out ior inspecUon and mainienance aRer loosening ihumb screv+? ❑ Yes ❑ tdo <br />I; BN1D locked into the proper posltlon and ihumb screw tipMened? ❑ Yes ❑ No <br />Circle ihe BWD cover. irrigation cover (landscape aree) ! traffic load beariny cover (drive sudace)1 access hatch (building) <br />Was property ovmer shown the iocalion of ihe installed BWD7 ❑ Yes ❑ Ro <br />Property Owner's SlgnaWro: <br />Commenis <br />Date: <br />Insfallers Signature: �7� ��j----- Date: �I — I S�' I T <br />Re��ision: 2 1 Monday, September 15, 2014 <br />