Laserfiche WebLink
a <br /> BACKWATER PREVENTION DEVICE FINAL <br /> 4.77. <br /> INSTALLATION CHECKLIST <br /> Installation Company Name and Contact Info: A /%i /% #iS,i� '57 /$eq <br /> Date Backwater Prevention device(BWD)was installed: Date this form was completed: - <br /> Installation Property Owner Name and Contact Info: jc&-i'r i>/cS ,1 <br /> Property Address: 5�f,2..7 fr7ce y 4' <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?❑Yes \No <br /> Are there fixtures in the house located below the upstream sewer manhole rim elevation?❑Yes 1No <br /> • Is the side sewer currently UNPROTECTED from sewer backups(does not have a BWD installed)?N,1 Yes 0 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? El Yes ❑No Condition: <br /> Does side sewer have at least 1%slope from the building to sewer main? ❑Yes ❑ No Describe: <br /> Have all building sewer drain connections to the side sewer been identified and located? ❑Yes ❑No <br /> Have all property storm drainage connections to the side sewer been identified and located? ❑Yes ❑ No <br /> Has property been evaluated for drainage deficiencies with findings communicated to property owner? 0 Yes ❑ No <br /> Installation Details: <br /> What type and brand of BWD was installed at this site(Clean Check BWV, Grinder pump,etc.): <br /> Where was the device installed (general description,attach 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? ❑Yes ❑ No Comments: <br /> Does BWD positioning meets minimum slope requirement of>1%? El Yes ❑ No 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? 0 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? El Yes ❑No Comments: <br /> Property Owner's Signature:` &i. _e5."-1- Date: <br /> Installer's Signatu Date: <br /> Revision:2 1 Friday,September 12,2014 <br />