1501 BROADWAY 2022-04-12 - Laserfiche WebLink

.� 4�,, BACKVUATER PREVENTIf�N DEV'ICE FINAL INSTALLATION CHECKLIST Insla'lalion Company Name and Contact Info: senrr�e DrtAIN SErtV�Ce 7 , 1� � •� `� Date Backwater Prevenlion device(BWD)�vas inslalled: '�-��f— 1.� Date this form was completed: ��rs ' Installation Property Owner Name and Contacl Info: navlD HOFFinaN - PrOp8rlyAddreSS: 1507 BROADWAY EVERETT WA 98201 _ ' Pre•Installation Inspection Checklist: All iferns musf 6e checked 'Yes'in order lor a BWD fo be considered lor insfallafion Is ihere a basement or level of the house that is at or near assumed see�er main elevation? � Yes o Are there fixtures in the house locatetl below the upstream sewer manhole rim elevation�e. n No Is ihe side sewer currently UNPROTECTED from sewer backups (does not have a BVVD instatled) afe u No Site Inspection Checklist: All items must 6e checked'Yes be/ore inspection is considered complete lNas s;:_�se�ti�er TV inspected from building to se��:er main? Yes o Condition: Ooes side se�ver have at least 190 slope from lhe building to se�ver mein a Ye I I No Describe: Have all building se�.ver drain conneclions lo the side sewer been identified and locate . es i No Have all property storm drainage conneclions to the side sev�er been identified and located. n Ye a No Has property been evaluated for drainage deficiencies wilh findings ccmmunicated to property o�vner ❑ Ye� I No Installation Delails: ��-, What type and brand of BWD was installed al this site(Clean Cheek BWV,Grinder pump, etc.J: ��-` ��Cy�� Wheie tivas Ihe device installed(general description, attach map)? �`�__�i��cT Was ihere any other sewer or slorm drainage work r,ompieted in con unclion wilh ihe BWD w rk Is so please describe: (\ �PS �;f�csri.C'L� �n� �w.SiJo�c2�r R�.�� _ i�C'\s231{� � Installation Checklist: 0'�- , �4/ (��l L� Are all downspouts and sile drainage disconnecled(rom upstream oI te BWD7 i es o Comments: Does BWD positioning meets minimum slope requirement of>t%7 I Es� o Comments� ___ Can BWD be pulled oul lor inspection antl maintenance alter loasening Ihi b screw. I Ye UJo Is BWD locked into Ihe pmper-pos�ion-a�ul-Ui�mb screw tightened ❑ Ye_.0 No Circle ihe BWD cove irrigation cover(landscape area�ylraKc load 6earing cover(dri�;�e�surface) I acces�s hatch (building) Was propedy owner sho�vn the localion of the installed 8WD?n Yes I 'o Comments: \J��L `5U U�de�� Property Owner's 5 re; i Date: �� I�S � �� �installer's Signature: _ _ Dale: � ' `C7LJ� Revision: 2 1 Monday, September 15, 7014