926 COLBY AVE 2022-04-13 - Laserfiche WebLink

� BACKWATER PREVENTION DEVICE FINAL INSTALLATION CHECKLIST InstallationCompanyNameandContacllnio: k�n-c� Pl.um3r�Cc 2p(v-qoCc— 09 e-9 Date Backwaler Preveni;;.n device (BWD) was insialled: ! Z-$ �¢ Date this form was mmpleted: �Z. - S- '4 Installation Property Owner Name and Contact Info: R� c,Uaon-!) LAN)w4 '`f'Z-i - Z l 2..g 4 3 6 Property Address: Pre-InsUllaGon Inspection Checklist: All items must be checked 'Yes' in order lor a BWD to be considered lor instaila6on Is there a basement or level at the house ihat is at or near assumed sewer main elevation? � Yes ❑ No Are there fiztures in the house located below the upstream sewer manhole rim elevation? � Yes ❑ No Is the side sewer curtenUy UNPROTECTED from sewer badcups (dces not have a BWD installed)7 � Yes ❑ No S(te Inspection Checkliat Ail dems musf be checked 'Yes' belore inspection is considered complete Was side sewer N inspected irom building to sewer main? (� Yes ❑ No Condi6on: Does side sewer have at least 1°n slope from the building to sewer main? � Yes ❑ No Desaibe: _ Have all building sewer drain connections to Ihe side sewer been identified and located7 � Yes ❑ No Have all property stortn drainage connectlons lo Ihe side sewer been iden6fied and located? � Yes ❑ No Has property been evaluated for drainage deficiendes with findings communipted to properry owne�t � Yes ❑ No Inshlladon Defafls: What type and brand oi BWD vras inslelled el ihis site Where was the device installed (general desaiplion,( BNN,Grinderpump,etc.)��[�7a✓ eN�ccK Was there any other sewer or storm dralnage work compieted in conjunction with the BWD work? Is so please desaibe: _ Installallon Checklist: Are all downspouts and site drainage disconnecled from upskeam ot the BWD7 � Yes ❑ No Comments: Dces BWD positioning meets minimum slope requirement of >t %7 � Yes ❑ No Comments: Can BWD be pulled out tor inspection and maintenance after loosening ihumb screw? (� Yes ❑ No Is BWD locked into lhe pmr�er osition and thumb screw Gghteoed? (� Yes ❑ No Circle the BWD cover in gation cove �andscape area)1 haffic load bea�ng cover (drive surface) / access hatch (building) Was property owner shown t e on of the installed BWD4 [� Yes ❑ No Comments: Property Owner's Signalure: Date: / Installer'sSignature: Dale: �2 ¢ �`� Revisfon: 2 1 Tuesday, September 16, 2014