732 COLBY AVE 2022-04-13 - Laserfiche WebLink

BACKWATER PREVENTION DEVICE FINAL INSTALLATION CHECKLIST Instaliation Company Name and Contacl Info: A+ Sewer Technolo�ies LLC, (888-213•7656) Dale backwaler device (BWD) was installed: 01/08/35 Date this form elas completed: 01/09/15 Inslallation Property O�vner Name and Contacl Info: Blake Scott Property Address: 732 Colbv Ave Evere.tt WA 98201 Pre•Installation Inspection Checklist: All ifems must 6e checked 'Ves' in order tor a BWD to be considered /orinstallation Is there a basement or level of the house that is at or near assumed se�:er main elevation? �✓ Yes ❑ No Are there fixlures in lhe house located helo�v ihe upstream sewer manhole rim elevation? �❑ Yes ❑ No Is the side sev�er currently UNPROTECTED trom se�ver backups (does not have a 84VD installed)? �✓ Yes ❑ No Site Inspection Checklist: All items must 6e checked 'Ves' be�ore inspection is considered complete VVas side se��rer TV inspeeted from building to sewer main? [� Yes ❑ No Condilion: Does side se�ti�er have al leasl t% slope from ihe building to sevrer main? 0✓ Yes ❑ No Descrihe� Have all building se�ver drain conneclions to the side sewer been idenlified and located? � Yes ❑ No Have all property storm drainage conneclions to Ihe side sev+er been identified and localed? � Yes ❑ No Has property been evaluate� for drainage deficiencies �vith findings communicated to property o�vner? ✓❑ Yes ❑ No Installation Detaiis: Whal type and brand oi BWD was installed at lhis site (Clean Check BWV, Grinder pump, @lC.): Gean Check Where �vas the device installed (general description, attach map)7 Aonro,c�matciv 10' from the front oorch of the house. Was there any other se�ver or slorm drainage work completed in conjunclion with the ABWD work? Is so please describe: Installation Checklist: Are ail downsposls and site drainage disconnected from upslream of the BWD9 ❑ Yes [] No Comments: Does BWV posilioning meel minimum slope requirement oi >i96? Q Yes ❑ No Comments: Can BWV be pulled out lor inspeclion and maintenance after loosening thumb scre�N? 0 Yes ❑ No Is BWV lacked into the proper position and thumb screw tightened? � Yes ❑ No Circie the BWV cover: irrigation cover (landscape area) I iraffic loatl bearing cover (drive surtace) I access hatch (building) Was homeowner shown the localion of lheinstalled ABWD7 �❑ Yes ❑ No Comments: Property Ov+ners 5ignalure: _�� Date: i' /� '�r �R ,�.,,....`I.. Installer's Signalure: Wa It ..�:"`'�"""'" '°� Date: 1/1212015_ Revision: 2 1 Thursday, Octobcr 02, 2014