Laserfiche WebLink
4En. BACKWATER PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> Installation Company Name and Contact Info: Baez, PLL)vk 63 NCB trL,. 0— Aft, -40(e-- p j'2„7 <br /> Date Backwater Prevention device(BWD)was installed:'—g" i S Date this form was completed:4—e -1 <br /> Installation Property Owner Name and Contact Info: <br /> Property Address: 2.45'0Cu �4 OTT N car— EVE L- -t- cam-_ 9j v/ <br /> Pre-Installation Inspection Checklist: <br /> All items must be checked Yes'in order for a BWD to be considered for installation <br /> Is there a basement or level of the house that is at or near assumed sewer main elevation? Ekres ❑No <br /> Are there fixtures in the house located below the upstream sewer manhole rim elevation?a Yes ❑ No <br /> Is the side sewer currently UNPROTECTED from sewer backups(does not have a BWD installed)? es ❑ No <br /> Site Inspection Checklist: <br /> All items must be checked Yes'before inspection is considered complete <br /> Was side sewer TV inspected from building to sewer main? giles ❑ No Condition: OK <br /> Does side sewer have at least 1%slope from the building to sewer main? krYes ❑ No Describe: <br /> Have all building sewer drain connections to the side sewer been identified and located? :E±Yes ❑ No <br /> Have all property storm drainage connections to the side sewer been identified and located? NiYes ❑ No <br /> Has property been evaluated for drainage deficiencies with findings communicated to property owner? ( Yes ❑ No <br /> Installation Details: <br /> What type and brand of BWD was installed at this site(Clean Check BWV, Grinder pump, etc.): C LC i _-) Cidccc <br /> Where was the device installed (general description, .ttach map ' <br /> Was there any other sewer or storm drainage work completed in conjunction with the BWD work? Is so please describe: <br /> Installation Checklist: <br /> Are all downspouts and site drainage disconnected from upstream of the BWD? ►7 Yes ❑ No Comments: <br /> Does BWD positioning meets minimum slope requirement of>1%? [ Yes SiNo Comments: <br /> Can BWD be pulled out for inspection and maintenance after loosening thumb screw? ❑Yes ❑ No <br /> Is BWD locked into the proper position and thumb screw tightened? , Yes ❑ No <br /> Circle the BWD cover: irrigation cover(landscape area)/traffic load bearing cover(drive surface)/access hatch (building) <br /> Was property owner shown the location of the installed BWD? p_'Yes (i No Comments: <br /> Property Owner's Signature: �r„c �. Date: / <br /> Installer's Signature:,"' Date: c 5 <br /> Revision:2 1 Tuesday,September 16,2014 <br />