Laserfiche WebLink
BACKvvATER <br /> PREVENTM DEME F NAL <br /> WSTALLATMM <br /> CHEE-CKUST <br /> A7nst2flaUlon Company Name and Contact info: <br /> Date Backwater Prevenilon device(BV@)was installed: 2 <br /> 11)8iallation ProDate this form was completed: q- <br /> tr OwnNtG <br /> pe er name and ContaGt Info: <br /> Property Address:` <br /> lRsPection Checklist: <br /> All items must be cha 01(6 d`Yes'in order for c?B WL)to be considered;or installatinn <br /> Is there a basement or level <br /> 0"the house that is at or near assumed sewer main e)evailon? <br /> Are there fixtures in the house located below the L—q yes No <br /> Is the silo Sewer currently UNPROTECTED from upstream sewer manhole rim MelevatiOn?0ye,5 EJNo <br /> Site 'r backups(does not have a MAID insjajle�,)? yea <br /> inapection <br /> All k-Ims must be checked`Yes'before inspection is cD17sjd81.Pd co PI" <br /> vitas side sewer'RI inspected f�OM ra �.a <br /> building I sewer main? <br /> Dop,.�side Sewer have LO yGs ED NO Condition: <br /> ve et least <br /> %SIOPe from the building to ae�,,j�r main? <br /> H,gvc-a!l building sewer drain conn Z Yes M No Describe; <br /> connections to the side saver been identified end 10cated? <br /> H2\1@ all PrOWLY storm drainage connections YES 0 No <br /> ' the side sewer been identified and located? No <br /> Lo i <br /> Has Pmp�nrbj been 6valuated for drainage deficiencies wi-ih findings communicated to properly myner? Erye <br /> What type and brand Y <br /> LCh <br /> I BVVD was installed at this site(Clean <br /> Where was the device installed(general det5cdptlon,attach map)?eck BWV, Grinder pump, etc.).- (C i <br /> 'PlaS there any other M%F OF Storm drainage <br /> work completed in conjunction with the BVVD work? Is 90 Please describe: <br /> Installation chec[I-Llist: <br /> Ara all downspouis and site drainage disconrtected from UP5tFearn of the BWD? Eyye5 Ll No Comments: <br /> DOGS BIND positioning meets minimum sfOP requirement of�,I%? [Eyes ONo Comments, ,J. <br /> Can BVVD be Pulled WL for inspeclLion and maintenance after loosening thumb screw? <br /> Lo <br /> L <br /> 'humb screw tghtened?�—ETY�S--Lj <br /> Is BVVD locked in, the PrOPE�F POSMOn and i <br /> Circle the BIND cover. I <br /> -09atigR-�r(landscape area)I tf8ffic;load bearing cover(drive surface)I access hatch(building) <br /> Was Property owner shown the 10ca6On Of the installed BVVD? IZYesFIIvo Comments, <br /> Proper�y Owner's Signature: <br /> InSfallel"s Signature: Date., <br /> Date: <br /> Revision:2 <br /> AhnndiV,September 15,2014 <br />