Laserfiche WebLink
i <br /> i <br /> ; <br /> � BACKWATER P'i�EVENTION DEVIGE FINAL. j <br /> � INSTALLATiON GHECKLIST � <br /> � <br /> ; <br /> -- i <br /> Insfallation Company Name and Co�'�ct In'o: 4�-.��v+�%�� � _qZ-� y ����Z� j <br /> Date Backvraler Prevention device (BWD)was installed: ��-� 7-/5 Date this form was completed: lo—1"7% S i <br /> � �' �f i <br /> Installation Property Owner Name antl Conlacl Inf : L/�_ ������-=�— � <br /> PropertyAddress: Z- l �(�"���a`-�a 1� ` <br /> i <br /> Pre•Installation Inspection Checklist: ? <br /> Afl items must 6e checked'�es'in order for a BWD!o be considered for insfallation � <br /> Is there a basement or level of lhe house that is al or near assumed sewer main elevation? [}'f� �No � <br /> Are lhere fixlures in the hou.,e located below the upstream sewer manhole rim elevation?[2�=es ❑No <br /> Is the side sewer currenUy UIJi'ROTECTED from sewer backups (does not have a BWD ins�alled)?[�es ❑No � <br /> , <br /> Site Inspection Checklist: � <br /> All items must 6e checked 'Yes'before inspection i� consrdered complete ; <br /> Was side se�ver TV inspected from building to se�aer main? [l}1`e�� No Condition�_ Q �- I <br /> � <br /> Does side sewer have at least 1%slope from th�;buildinn b sevrer main? �1es- ❑No Describe: ; <br /> Have all building sewer drain conneetions to th�side se, b°en identified and locafed7 (�.Yes-� No � <br /> Have all properly storm drainage connectionr;to the side sev:er been idenlifietl and Iccated? n Y� ❑No ; <br /> Has property been evaluated for drainage deficiencies with findings communioatetl to property ovmer? �Xes ❑ No ; <br /> Installatian Details: �,/� / � <br /> Whal type and brand of BVJD was installed at i���sile�lea�Grinder pump,etcJ: CJ�-�--�-�%C.��-��-- <br /> Where�vas the device insfalled(general description, attach map)? _ Q � 1-� ! <br /> i <br /> Was Ihere any other se�ver or storm drainage v o k completed in conjunelion v�ith the BW ��Nork?Is so please describe:_ i <br /> G�-e� <br /> i <br /> — ; <br /> Installation Che�klist: <br /> Are ail downspouts and sile drainage disconnected from upslream of the BWD? [�]Yes ❑ No Commenls: � <br /> Does BWD positioning meets minimum slope requirement of>1%? [C�-Yes ❑ No Commenis: � <br /> Can B�ND be pulled out for inspection and maintenance afler loosening thumb screw7 t0-- Yes ❑No <br /> Is BVJD locked into the proper positio uE#L�� tightened7 t[�-1Fes ❑Ido I. <br /> �ircle lhe BWD cover: irrigation c er(landscape area)l��r ffic load bearing cover(drive surace)1 access hatch (building) ; <br /> Was properly owner shc.vn the locali e msfalled BWD? ��fcS [j No Comments: <br /> r �� <br /> Property O�vner's oi�£�' Data: �'�?' � J � <br /> Installer's SignaWre:� Date: ��l 7 - (S � <br /> i <br /> Revision: 2 ] Friday, September 12, 201.4 ! <br /> I <br />