Laserfiche WebLink
BACKINATER PRE�/ENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> ��Z � <br /> Installation Company Name and Contact Info: fj��i ic� j�J -.-r 1�%,.c 3 Fs 7 '' �Sa7 <br /> Date Sackwater Prevention device(BWD)v�as installed: � Z / Date this form was completed: / � �� <br /> Installation Property Owner N�me and Contact Info: tG iv�n w.i I/o. � �S�.— (� 77.� <br /> PropertyAddress: J]i/ Zl��`� sr ` — <br /> Pre•Installation Inspection Checklist: <br /> Ali items must 6e checked'Yes'in order for a BWD to 6e considered forinstallation <br /> Is there a basement or level of the house that is at or near assumed sewer.main elevation7 �Yes ❑No <br /> Are Ihere fixlures i!�the house lopted below the upsUeam sewer manhole rim elevation7�]Yes ❑No ; <br /> Is the side sewer curtently UNPROTECTED from sewer bsckups(does not have a 8WD installed)?�]Yes ❑No � <br /> Site Inspecfion Checklist: � <br /> All items must 6e aiecked'Yes'before inspeclion is considered complete <br /> Was side sewer N inspected from building to sewer main? ��'es ❑No CondiGon: c <br /> Does side sewer have at least 1%slope from the building to sewer mai�? �Yes ❑No Describe: <br /> Have ail building sewer drain connections to the side sewer been idenUfied and located? �Yes ❑No <br /> Have all property storm drainage connections to ihe side sewer been ident�ed and located? �Yes ❑No I� <br /> Has property been evaluated for drainage deficiencies wilh findings communipted to property ownefl �Yes ❑ No � <br /> Installatlon Detalls: �--� I <br /> Whal type and brand of BWD was installed at lhi te-r..,ean Che°r ck BWV,Grinder pump,etc.): <br /> Where was Ihe device inslalled(general descr tiom;attach'map)"?'--�e+�'�e/' h��-cS� 4/p rJ � <br /> j <br /> Was there any other sewer or stortn drainage work completed in conjunction with ihe BWD work?Is so please descrihe:_ � <br /> ��,��oh /n o4sopn u��4. � <br /> Installation Checklist: <br /> Are all downspouts and site drainage disconnected froT upstream oi the B D7 Yes ❑No CommenLs: <br /> Does BWD posiGoning meets minimum slope requirement of>1%7 Yes ❑No Comments: � <br /> Can BWD be pulled oui for inspecbon and maintenance after loosening lhumb screw?�Yes ❑No � <br /> Is BWD locked into the proper os'i and Ihumb [gSYti htened?�(Yes ❑No � <br /> Circle ihe BWD cover.irtiga6o�ver-(landscape are�J�fic load bearing cover(drive sur(ace)I access hatch(building) + <br /> Was property owner shown the localion of the inslalled BWD? �Yes ❑No Comments: � <br /> Property Owners Signature:� �.— i , , Date: 1/Z Z/i� <br /> Instal!:rsSignaWr • �------ Dale: _��Z�/� <br /> Revision:2 1 Friday,September 12,2014 <br />