Laserfiche WebLink
� <br />� <br />BACKWATER PREVENTION DEVICE FINAL <br />INSTALLATION CHECKLIST <br />Installation Company Name and Contact Info: M U e-/� <br />���. r-� `' 1 <br />Date Backwaler Prevention device (BWD) was inslalled: ���.� - I S <br />Installation Properfy Owner Name and Contacl Info: �✓ i ����- /Z <br />Property Address: <br />I13 ��`` S� <br />S 7�U f?( <br />� this fcrm �,vas completed: I' 10� IS <br />� �' l�� <br />Pre•installation Inspection Checklist: <br />All items must be checked 'Yes' in order for a BIND to be considered tor instailation <br />Is ihere a basement or level of the house that is at or near assumed se��der main elevation?� Yes ❑ No <br />Are there fixtures in the hou:;e located below tne upstream se:ver manhole rim elevation? �Yes ❑ No <br />Is the side sewer currently UNPROTECTED from sevaer backups (does not have a BWD installed)7 � Yes ❑ No <br />Site Inspection Checklist: <br />pl1 items musf be checked 'Yes' before inspec(ion is considered camplete <br />���as side sev�zr TV inspected from building to sevrer main? � Yes ❑ No Condilion; �i—�.;� <br />Does side sev;er have at least 1% slopz from the buildiny to se��er main7 � Yes ❑ No Describe: � <br />Hat�e ali builtling sewer drain conne�tions to the side setiver been idenlified and locafed? � Yes ❑ No <br />Have all preperty storm drainage connecfions to the side sev,�er been itlentified and located? � Yes ❑ No <br />Has properiy been evaluated for drainage deficiencies ���ith findings communicated to propedy owner7 � Yes ❑ No <br />Installation Details: <br />What type and brand of BWD was inslalled at fhis site (Clean Check BWV, Grinder pump, etc.): C� p(�) <br />lNhere eaas the device installed (general description, attach map)? 0�,.� s�� 1rn.�v�„•f— ,� �- 5, � <br />r __ . <br />INas there any�other sewer or storm drainage work completed in conjunction vrith the �WD v�ork? Is so please describe: <br />Installation Checkiist: <br />F1re all downspouts and site drainage disconnecled from upstream of the B14�D? (J� Yes ❑ No Comments: <br />Coes BWD positioning meets minlmum siope requirement of >1°io? Q Yes ❑ No Comments: <br />Can BWD be pulled oui (or inspection and maintenance aiter loosening thumb screw? � Yes ❑ No <br />Is BWD locked inlo the proper position and thumb srrew tightened? �j Yes ❑ No <br />Circle the 8WU cover:Frigaiion cove (landscape area) / tranc load bearing cover (drive s���iace)1 access hatch (huilding) <br />Was properiy ovmer shown the Iccation of Ihe instalied BWD? � Yes ❑ No Comments: <br />Property Ovmer's Signature: Dafe: <br />Insfaller's Signature: � �%�--L__ Date: ��� ��� S <br />Revision: 2 1 fvlonday, September 15, 2014 <br />