Laserfiche WebLink
� <br /> I <br /> BACKWATER PREVENTION DEVICE FINAL � <br /> INSTALLATION CHECKLIST I <br /> � <br /> i <br /> r <br /> 1� <br /> Installation Company Name and Contaci Into: c��s P�uMeiNc s seavice��c sso�ssi-siss � <br /> Dale Backwater Prevention device(BWD)was inslalled: �-'Z-�r� Dale this form was compleled: 6`/z-' � i <br /> Installalion Property Owner Name and Conlact In(o: ��� �'h��` M4'� ' <br /> Property Address:\ln 1�1 Oa1< < (1 s.� ��`u� c S.4- - � <br /> � <br /> Pre•Installation Inspection Checkiist: i <br /> All items must he checked 'Yes'in order for a 8WD to be considered for installafion � <br /> Is there a basement or level o(Ihe house that is al or near assumed sewer main elevation?�Yes ❑ No = <br /> Are there fixtures in the house lucafed below the upslream sewer manhole rim elevation?�Yes ❑ No � <br /> Is the side sewer currently UNPROTECTED irom sewer 6ackups(does nol have a BWD inslalled)?�Yes ❑ No j <br /> � <br /> Sile Inspection Checklist: <br /> AIf items musf 6e checked'Yes'before inspeciion is considered cornplete � <br /> Was side sewer TV inspected(rom building to se�ver main? [�Yes ❑ No Condition:4�•�c- �a�.-� �o� Clw+ i <br /> Does side sewer have ai least 1% slope(rom lhe building lo se�ver main? [/]Yes ❑No Describe: � <br /> Have all buildin� sewer drain connections to the side sewer been identified and located7 [�Yes ❑No <br /> i <br /> Have all property storm drainage conneclions to Ihe side sev�er beeu itlentified and located? �Yes ❑ No <br /> Has properiy beer evalualed for drainage deficiencies v�ith findings communicaled lo property oNner? (],�Yes ❑ No � <br /> Installxlion Details: ; <br /> What lype and brano o(BWO was inslalled at this sile(Clean Check BWV, Grinder pump, elc.):'P��- e\�,"u (��u-�4 ; <br /> UJhere�vas lhe device installed (general description, allach map)? u��L� �,� ���%��' �c�� �,'� ' <br /> I <br /> �� � - . �u J— � <br /> Was ihere any other sewer or storm drainage v�ork compleled in conjunction wilh 1he E3WD�vork?Is so please describe:_ i <br /> � <br /> 1_ i�.(1 y�,�y, (`��x�� \�,�cc:_,� \.._� ; <br /> �- . <br /> Inslallation Checkii�t: � <br /> Are all downspouts and site drainage disconnecled from upsiream of the BWD? [1�]Yes ❑ No Commenis: <br /> Does Bl'JD positioning meets minimum slope requirement of>t%? �1'es j]No Commenls: <br /> Can BWD be pulled oul for inspection and maintenance afler loosening ihumb screw? �/]Yes ❑No � <br /> Is BWD locked into the proper posilion and Ihumb screw tighlened? �Yes ❑ No i <br /> Circle lhe BWD cover. irrigation cover(lantlscape area}!iraffic load bearing cover(drive suriace)I access hatch (building) ' <br /> �Plas properiy owner shown the localion o(lhe in alled BWD? [a Yes ❑ No CommeNs: ; <br /> Properly Owner's Signah -�' /' ' il�— Dale: � �J� � <br /> Installer'sSignalure: � Dale: �j -' !Z- 1S <br /> Revision: 7 1 Friday,Seplember]2, 2014 <br /> i <br />