Laserfiche WebLink
� <br />� <br />BACKWATER PREVENTION DEVICE FINAL <br />INSTALLATION CHECKLIST <br />Installation Company Name and Conlact Info: ! � � �` `�'� <br />Date BacMvater Prevention device (BWD) was installe :�-� -� S Date this form was compieleo: rl - i-�� <br />installalion Properfy Ovrner Name and Contacl Infe: � n nn� n�( �� C-��`�-� <br />Property Nddress: __{��I l 1 <br />Pre-Instailation Inspection Checkiist: <br />l+II items musl6e checked 'Yes' in order for a BWD to be considered for instaflation <br />Is there a basement or level of the house that is at or near assumed seraer main elevation? � Yes ❑ No <br />Are there fix�ures in ihe house located belo,s� the upsUeam se�ver manhole rim elevation? �] Yes ❑ No <br />Is the side sewer currently UNPROTEC7ED from sewer backups (does not have a DWD installed)7 [�] Yes ❑ IJo <br />Site Inspection Checklist: <br />All items must be checked 'Yes' before inspeciion is considered campfele <br />Was side sewer N inspe�ted from building lo setver main? � Yes ❑ No Condifion: <br />�oes side set��er have at leasll",o slope from the building to sewer main? [�] Yes ❑ No Describe: <br />Have ail huiltling sev+er drain conneciions to the side seK�er been identifietl and located? �Yes ❑ No <br />Have all property stomi drainage connections to ihe side sev�er been identified and located7 �j Yes ❑ No <br />Has property been evaluated (or drainage deficiencies wilh findings crommunicated to property ovrner'T (� Yes ❑ No <br />/ � <br />Installalion Details: �-- � <br />UJhat fype and brand of BN'D was inslalled at this sit (Clean Check BWV tinder pu`r'np, etc.)' <br />VJhere vras lhe device inslalled (general deseription, atlac "fiap . �{��n�'�_�__ �i (� � � �``� <br />N'as ihere any other se�ver or storm drainage work <br />viilh ihe BWD work7 Is so please descri6e: _ <br />Installalion Checklisf: • <br />Are all downspouts and sile drainage disconne�tetl from upslream of the BWD7 �Yes ❑ No Comments: _ <br />Does BWD positioning mees minimum slope requiremenl of >1%? �] Yes ❑ No Commenls: <br />Can t3WD be pulied out (nr %ins �cfion;�nd ainlenance afler loosening ihumb scre�v7 `�Yes ❑ No <br />Is B�VD locked into U(�+pr p6 er positlon and th�oretiv tightened? � Yes ❑ No <br />Circle the BWD covetu�ri�tion covE�(aertdscape area)1 tralfic load 6earing cover (drivo surface) I access hatch (building) <br />Was properiy ov+ner shown the location o( the installed BiND9 � Yes ❑ No Comments: <br />Property Ownet's Signature: Date: <br />Insto.,ers Signature: - Date: � i-� l� <br />Hevision: 7 /1 Friday, Septembcr 12, 2014 <br />