Laserfiche WebLink
f3AC�CVl1/aTE� Pl�EVENTI�Id �E1���E Fi�IAL <br />� �IVST�►LL�►,TION CH{ECKL�Si <br />i°Y}��C`"� ���� �;���c'i �'—� �' �%� .��z. ��-�.'_�� � �...�-� <br />]nstailatian Company Name and Contact Enfa:���,�'-� �i�r',C�; 4�'��1�^�����"� ��� �'�"�� y'`' �� �����' "�--���}`�� <br />Date 8ackwater Prevention device (BWD} was installed: ��� Date this form was comple#ed: <br />�� - <br />lnsta{(ation ProperEy Ownsr Name and Contact 1nfo: � -� " <br />Proper�y Address: ,��� �,�'°d � ���`�� � �-��--�� <br />Pre-Installation Inspection Check[ist; <br />AJl items must be checked `Yes' in arder for a BWD fo be consrdered for insfallafion <br />1s ihere a basement or levef of the house that is at or near assumed sewer main elevation? �4'es ❑ No <br />Are fhere fixtures in the house Eocated befow the upstream sewer manhole rim elevation? [�Yes ❑ No <br />Is the side sewer currentiy UI�PR�T�CTED from sewer backups �does not have a BWD instalfed)? �Yes ❑ No <br />Site Inspection Checklist; <br />Atl items must be checked `Yes' before inspecfion is considered camplete <br />Was side sewer TV inspected from building to sewer main? [�r'es ❑ fVo Condition: �'��`� <br />l <br />Does side sewer have at least 1% slope from the building to sewer main? �'es ❑ No Describe: <br />Have all 6uilding sewer drain eonnections to the side sewer been identified and located? [�Yes ❑ No <br />Have all property storm drainage connectians to the side sewer been identified and located? [�.�'es ❑ No <br />Nas property been evalua�ed far drainage deficienc�es with findings communicated ta proper�y owner? �Yes ❑ Na <br />lnsfiallation Details: <br />What type antl brand of BWD was installed at this site {Clean Check BWV> Grinder pump, etc.): �' � <br />Where was the device installed (general tlescription, attach map)? �" f' -� f'��� '��� ��'" <br />Was there any other sewer or s#orm drainage work completed in conjunction with the BUUQ work? !s so please describe: <br />, �_„ <br />InstaUation Checkiist: <br />Are a1! downspoUts and si#e drainage disconnected frorn upstream of #he BUUD? es ❑ No Commen#s� <br />Daes BWQ positioning meets minimum slope requirement of >9 %? �Yes No Comments: <br />Can BWD be puEled out far �nspection and maintenance af�er loosening thumb screw? �,Yes ❑ No <br />fs BWD lacked into the pro er.�.ositian and thumb screw tightened? �Yes ❑ No ` <br />Circle the BWD cov : irrigation cov_er scape area) I traffic load bearing cover (drive surFace} I access hatch (building} <br />Was property awner s own the location of the insta[[ed 8WD?� Yes ❑ No Comments: <br />Property Owner's Sic <br />Installer's 5ignature: <br />Revision: 2 <br />Date: G- "�! � � /� <br />Date: � � i�y _.z' G� <br />Friday, September 12, 2014 <br />