Laserfiche WebLink
i <br /> BACKWATER PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> YC ��- 49� _ OL27 <br /> installation Company Name and Contact info: <br /> Date Backwater Prevention device(BWD)was installed: z— �_— : Date this Corm was comoieTa,� S� <br /> Installation Property Owner Name and Contact Info: <br /> TOProperty Address: ' <br /> Pre-installation Inspection Checklist: <br /> All items must be checked `Yes'in order for a BWD to be considered for instailatibr <br /> Is there a basement or level of the house that is at or near assumed sewer main elevation? C 9'j❑ No F <br /> Are there fixtures in the house located below the upstream sewer manhole rim elevation?ms` s�❑No <br /> Is the side sewer currently UNPROTECTED from sewer backups(does not have a BWD installed)? [mss' ❑No <br /> Site Inspection Checklist: <br /> All items must be checked'Yes'before inspection is considered complete <br /> i <br /> Was side sewer TV inspected from building to sewer main? EI-Yes ❑No Condition: <br /> Does side sewer have at least 1%slope from the building to sewer main? [D5Y6s' ❑No Describe: <br /> i. <br /> Have all building sewer drain connections to the side sewer been identified and located? ❑*-, '-❑No <br /> a <br /> Have all property storm drainage connections to the side sewer been identified and located? (I.Yes ❑ No a <br /> Has property been evaluated for drainage deficiencies with findings communicated to property owner? E�,� ❑ 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 mapp <br /> i <br /> i <br /> Was there anv other sewer or storm drainae 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? ❑Yes ilo Comments: r1 f <br /> Does BWD,positioning meets minimum slope requirement of>1%? ❑No Comments: <br /> Can BWD be pulled out for inspection and maintenance after loosening thumb screw? U_Y� No <br /> Is BWD locked into the proper position and thumbscrew tightened?,.Aq-*eNo <br /> Circle the BWD cover: irrigation cover(landscape area)/f�ffic load bearingcov 41664 surface)I access hatch(building) <br /> Was property owner shown the location of the install BWD? (�.Y " No Commend: <br /> AA <br /> Property Owner's Signa Date: 5 ' I <br /> l <br /> Installer's Signature, �" Date, "A +� <br /> Revision: 2 Friday,September Z 2_2014 <br />