Laserfiche WebLink
� ` � ` ., . <br />�! �� N ��� ��` ��„ <br />�� ,►, � �i - <br />�'��`"� ���°� <br />� <br />t� <br />- , a - ,, r � �, • ; �. $ . � . �j , ;• � _ ..� .- :� <br />. a.....3 �.5�' � � � . " �� ' , <br />installation Company Name and Cantact lnfa:�� . �ate this form was compieted: � <br />Date Backwater Prevention device (BWD) �as instaiied: ` �� � � ` ' <br />��� , � �� ' �. ' <br />Instailation Property Owner Name and Contaet lnfo, � .i ^ . � � ( ��� �' <br />Praperty Address. <br />Pre-Instailatian (nspection Checklist: <br />All rtems must be checked `Yes' in order for a BWD io be conside�� s��er m�a nf elevation? [�1'�� � N° <br />(s there a basement ar level of the house that is at ar near assum <br />Are the <br />ce #ixtures in the house locate� below the upstream sewer manhole rim elevation? C+�Ye� �� Yes [( Na <br />ls the side sewer currently UNPR07EC1�ED from sewer backups (does nat have a BWD {�►5���� ) <br />�ite ins�ectinn Checktist: <br />A!f items must be checked `Yes' befc�re inspe�tior� is considered comp(ete ��C _ l <br />� 7�t <br />❑ i�lo Condition: <br />tN�s side sewe� �'V inspected from buifding to sewer main? �s ,� Yes ❑ No Desctibe: <br />Does side sew�r have at [east 1%a sfape f�Qm the building to sewer ma�n . C� <br />I{ bltllCiiTl sewer drain connections to the side sewer been identified and loca#ed? �eSY� Q No <br />Have a 9 <br />Have all praperty starm drainage connections to the si de sewer b e e n i d e n t��e� d���� �o � a���y oWn��� �Y�S ❑�o <br />Has property been evaluated for drainage d e f i c i e n c i e s w i t h f i n d � n 9� c o m m <br />lnsfallation Details: etc.): e __�� � <br />What type and brand of BWD was installed at this site (Glean Check BWV, Grinder pump, � <br />Where was the device instal4ed {general description, attach map) . <br />Was there any �ther sewer or storrn drainage work completed in �o <br />ction with the BWD work? ts so please describe: � <br />tnsialtation Checklist; <br />II downs outs and site �rainage disconnected fram upstream of the SWI7? ` Yes �m �ts�omments; _,____._— <br />Are a P � <br />Qaes 8WD positioning meets minirnum slope requirement of >�.°lo? ��uinb screw C Yes [] No <br />�an g1Np be puiled nutfor inspectian and maintenance a�ker laosening o� <br />Is BWD lacked into the prop��`-p�s►t«.n and thumb screw tightened? i�.Y� ��� drive surfacej J access hatch �building) <br />,-w'. <br />Circle the BWD cov �rrigatian cove�_ ndscape area} 1 traif� load bearmg� No �amments: <br />�.� �.� -a � _.. (�e <br />Was property oWner shown the io ation of the i a ed BWD � [� (� <br />� ,�� Date: <br />�t1� ,, <br />Property Owner's Signature� Date: �'� <br />_ f� _ <br />{nstafler's Sig <br />1 <br />Revision: � <br />Friday, September 12, 2014 <br />