Laserfiche WebLink
' BACKWATER PREVENTION DEVICE FINAL <br />E� INSTALLATION CHECKLIST <br />Installation Company Name and Contact into: 7� /� �m��'J!✓+� �C-� 1�Z{� �rQ�1—�CZ-3 <br />Date Back�vater Prevention device (BWD) ta�as installed: 1�i- /�� Dale t'nis iorm ti;�as completed: /- ��- /,ti <br />Installalion Properiy O��;ner IJame and Contact Info: �il%r�i � 9%vne( rf� �Z - �� � 7 <br />Property Address: /7 / 3 � a'L S � "��� �' �'--`�� <br />Pre-Installation Inspection Checkiist: <br />All items must be checked 'Yes' in order for a BV��D to be considered ior instaliation <br />Is there a basemen't or leael of the houss that is at or near assumed sevaer main elevation? es ❑ No <br />Are there fixtures in the house located belo�,•: the upstream sevder manhole rim elevation? �'f es ❑ No <br />Is the side ser��er curren0y UNPROTECTED from se���er backups (does not have a BWD installed)? �'�es ❑ No <br />Site Inspection Checklist: ' <br />� c�r!/ <br />Fill items must be checked 'Yes' before inspection is considered complefe <br />Was side see��er TV inspected from building to seia�er main? [�'f2� ❑ No Condition: �� ��"L �� <br />Does slde see�er have at least 1% slope from lhe building lo se�ver main? [i.J�`� ❑ No Describe: <br />Have all buildir�g sewer drain connections to the side sevder been identi5ed and located? �❑ No <br />Have all property storm drainage connections to the side se�ver been identified and located? [a�s ❑ No <br />Has properiy been e��aluated for drainage deficiencies vrith findings communicated to property o��ioer? [�-}i`Es ❑ No <br />Installation Detaiis: <br />'Nhat type and brand of 3WD vaas inslalled at this site (Clean Check BWV, Grinder pump, etc.): i�� w- GL.,-c.,L <br />N.�here e�as the device installed (general description, attach map)? i'.�Gv'-a� �'�eF�-w�— <br />� r, � a� _cs� h�e- cr��- z�T'` �� <br />Vdas ihere any other se�ver or storm drainage v,�ork completed in conjunction �vith the BIND work? Is so piease describe: _ <br />n,� � <br />Installation Checklist: <br />Are all downspoufs and site drainage disconnecied from upstream oi ihe BVJD? �s ❑ No Comments: <br />Does BIND positioning meets minimum slope requirement oi >t°/a %� es ❑ No Comments: <br />Can 81ND be pulled out for inspection and maintenance after loosening thumb scre�v? [a'Pes ❑ �o <br />Is 61ND locked into the proper position and ihumb scre�v lightened? ,�s ❑ No <br />Cirde ihe BWD cover. irrigation cover (landscape area) � tra(f��arina rn�'�rive surface) I access hatch (building) <br />VJas property owner shown the localion of ihe installed BWD? es ❑ No Comments: S����"� <br />Pronerty0vaner'sSigna(ure: %�e-� Date: [-aB- iS <br />Installer's Signalure: �� � Date: /—a-'!—I � <br />Revision: 2 1 Friday, Septemher 12, 2014 <br />