Laserfiche WebLink
BACKWATER PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> Amrtcan <br /> Installation Company Name and Contact Info*--T Oi-qe —C <br /> Date Backwater Prevention device (BWD)was installed: /13�/6 Date this form was completed: <br /> 6 IQ_itlorl 464 ::7 <br /> Installation Property Owner Name and Contact Info: C, t 462 <br /> Property Address: QP,0_�> G1 <br /> Pro-installation Inspection Checklist: <br /> All items must be checked Tes'in order for a BWD to be considered for installation <br /> Is there a basement or level of the house that is at or near assumed sewer main elevation?0--yes ❑F� No <br /> Are there fixtures in the house located below the upstream sewer manhole rim elevation? [ i-Yes n No <br /> Is the side sewer currently UNPROTECTED from sewer backups (does not have.2 BWD inst2lled)?"WNes F1 No <br /> Site Inspection Checklist: <br /> All items must be checked'Yes'before inspection is considered complete <br /> Was side sewer TV inspected from building to sewer main? <br /> VP(es 0 Na Condition: 17Cu <br /> Does side sewer have at least 1% slope from the building to sewer main? -'Yes El No Describe: <br /> Have all building sewer drain connections to the side sewer been identified and located? ( eS 0 No T , <br /> Have all property storm drainage connections to the side sewer been identified and located? r-Q-Yes F1 No <br /> L_ <br /> Has property been evaluated for drainage deficiencies with findings communicated to property owner? PYes El No <br /> Installation Details: <br /> What type and brand of BWD was installed at this site(Clean Check BWV, Grinder pump, etc.): <br /> Where was the device installed (general description, attach map)? 1C, <br /> Was there any other sewer or storm drainage work completed in conjunction with the BWD work? Is so please describe: <br /> Installation Checklist: <br /> Are all downspouts and site drainage disconnected from upstream of the BWD? ayes [] No Comments: <br /> Does BWD positioning meets minimum slope requirement of>1%? E2s E] No Comments: <br /> Can BWD be pulled out for inspection and maintenance after loosening thumbscrew? 54-yes E] No <br /> Is BWD locked into the proppr,pg5ition and thumb screw tightened? ; 'Yes El No <br /> Circle the BWD cover(Lirri�gation (building) <br /> ,_ ndscape area)/traffic load bearing cover(drive surface) access hatch (b ding) <br /> Was property owner shown the location of the installed BWD? ;B Yes El No Comments: <br /> Date: <br /> Property Owner's Signature: <br /> Installer's Signature: Date, <br /> Revision:2 1 Friday,September 12, 2014 <br />