1801 COLBY AVE 2022-04-13 - Laserfiche WebLink

BACKWATER PREVENTION DEVICE FINAL �. INSTALLATION CHECKLIST Installalion Company Name and Contact Info: /1r"c�/�U ��Gcir�f r�G / �P� S� �S7" 5�1753 Dale Backwater Prevention device(BVJD)was inslalled:�/S�/.f _Date this form was compieted: ��S /.r Installation Property Owner Name and Conlacl Info:,Ma�y 13�//o r.�, ��ZS� "�.S 7- 9GS 3 ProperlyAddress: I�SG� Gal3Y ��'��'�'f w�' Y�zc/ Pre•Instc:lation Inspection Checklist: All items must 6e checked'Yes'in order for a BIND to 6e considered tor installafion Is Ihere a basement or level o(the house that is at or near assumed sewer main eievation? �]Yes ❑ No Are there f xtures in Ihe house localed below Ihe upslream sev�er manhole rim elevation?�Yes ❑No Is Ihe side sewer currently UNPROTECTED from se�ver backups(does not heve a BI�V�inslalled)?�Yes ❑ho Site Inspection Checklist: All items must 6e checked'Yes'before inspecfion is considered c�mplc!e VVas side sewer N inspected from buiiding to sewer main? �Yes ❑No Condition: Does side sewer have al least 1%slope from Ihe building to sev�er main? [�Yes ❑No Describe: � � Have all 6uilding sewer drain connections lo Ihe side sev+er been identified and localed? Q Yes ❑No Have all prope�ty slorm drainage connections to the side seerer been identified and located? �Yes ❑ No Has property been evaluated for drainage defciencies with findings communicated to properly owner? �Yes ❑No Installation Details: 4Vhat type and brand oi B`ND�vas inslalled at this si an Check 81 ,Grinder pump,etc.): _ Where�vas ihe tlevice installed(generai description, ac map)? �uG��,v c�.�D n/J� lcin Nr' /t; i,1 o F� wn/la.w<< VJas there any olher sewer or slorm drainage work completed in conjwction with the BWD e:ork?Is so please descriGe:_ N9 Installation Checkiist: Are all downspouls and sile drainage disconnected from upslream of the BWD7 I%I Yes ❑No Commenis: Docs BWD posilioning meels minimum slopo requiremenl of>1°a? �Yes ❑No Commenis: Can BWD be pulled oul for inspeciion and mainte�ance after loosening lhumb screw7 �]Yes ❑No Is BWD locked into Ihe proper position and thumb_screw lighlened? �]Yes ❑No� Circle the BWD cov gahon cover(Iandscap�ceajtfraKc load tiearing cover(drive surlace)1 access hatch(building) 1h'as property owner sho� ocation of Ihe inslalied BiA'D? ry�Yes ❑ No Commenls: Property Ovrners Signature• ��< - � � Date� �lS� �r/1� Installer's Signat� Date: /�T, ?�) � � Revision:2 ] Friday,September 12, 2014