2122 BAKER AVE 2022-04-12 - Laserfiche WebLink

BACKWATER PREVENTION DEVICE FINAL � INSTALLATION CHECKLIST Installation Company Name and Contact Info: S �� ' � �+-� S,� �.:<•�,. I �'' �- �I2� - �II�- 7�•� Z Date Backwater Prevenlion device(BWD)was instailed: �I � I 'i - �`� Dale ihis(orm was completed: '-I � I L - 1 L> Installation Property Owner Name and Conlact Info: L L N�/"� E L _�/2�, 3 S'� - Property Address Z � 1-Z IS �� K L l� !-1 �'G -- Pre•Installation Inspection Ghecklist: �II ifems must be checked 'Yes'in order lor a BWD b be considered(or installatron Is Ihere a basement or Icvel o(the house ihat is at or near assumed sewer main elevation?j]X Yes ❑No Are therc fixtures in the house located helow the upstream sev�er manhole rim elevation?�]' Yes ❑ No Is the side sewer currentiy UNPROTECtED from sewer backups (d::es not na��e a 9WD installed)��j Yes [J No Site Inspection Checklist: All items must 6e checked 'Yes'belore inspection is considered complete Was siae sewer TV inspected(rom bwlding to sewer main? (�Yes ❑ No Condilion: �-� �•�� Does side sewer have at leasl t%slope from the building to sevrer main? (�Yes ❑ No Desaibe: Have all building sewer drain conneclions to ihe side sewer been identified and located? �Yes ❑ No � Have all property s(orm drainage conneclions to ihe side sev�er been idenidied and located? �Yes ❑ No Has property been evalualed lor drainage deticiencies v�ith(indings communicated to properly owner? �Yes ❑ No Installation Details: � What type and brand o(�WD was inslalled at ihis sit (Clean Cher,k BWV�Grinder pump, elc.): _.__ �- --- _. Where�vas ihe device inslalled(general description, aUach map)7 �✓i,...�-c,,.. •i l.� /i.:.,5�_ q„< ( _ _�� -; ; ,,�� .�_; �� F� c�<<��..�� ,� ��—� ' s o� NU t.Y..�,., ��,�� Was there any ulher sewer or storm drainage work completed in conjunclion wilh ihe BWD work? Is so please describe _ �V (� Installalion Checklist: Arr all dotvnspouls and site drainage disconnected from ups�ream ol the �WD? �� Yes �] No Commenls: Docs BWD positioning meets minimum slope requirement of>t9b? 0 Yes ❑No Commenis Can BIND be pulled out lor inspection and main(enance after loosening thumb scre�v7 [{� Yes ❑No Is BWD locked into the proper posil!on and Ihumb sr,re�v tightened7 f?] Ycs ❑ No Circle the BWD cove irri�gation co�ve�landscape area)I Iraffic load bearmg cover(drive surface) I access halch (building) Was property owner shown lhe location o(ihe installed B � � Yes ❑ No Commenis _ Property Owner'sSignalure: � �� ____ / Date: y�/J ��s� � . --��Q�'"`"y��-_ _ Installer's 5ignalure:��._____ ___. ______ Dale: �1 - I� -I�_ Revision: 2 1 Friday, Septemher 17, J014