4007 FEDERAL AVE 2022-04-15 - Laserfiche WebLink

� BACKWATER PRENENTIAN DEVICE FINAL INSTAl.LATION CHECKLIST Installation Company Name and Contact Info: f}Poi,� �'lr,�M�3in�r 3<s�— �f�7 Date Backwater Prevention device (BWD) was installed: Date this fortn was ccmpleted: installation Property Owner Name and Contact Info:.Ter�n i�C� S� /ve �S `�1sJ 737 - �973 PropertyAddress:1�7 YCi7e��'/ f�✓e Pre•Installation Inspectian Checklist: All rtems must be checked �Yes' in order for a BbL'D to be considered for installation Is there a basement or level of the house that is at or near assumed sewer main elevationl � Yes ❑ No Are there fixlures in the house located helow the upstream sewer manhole rim elevation? i❑ Yes ❑ No Is lhe side sewer curcenliy UNPROTECTED from sewer backups (does nof have a BWD installed)?�] Yes ❑ No SKe Inspection Checklist: All items must 6e checked'Yes' be(ore inspection is considered complefe Was side sewer N inspected from building to sewer main7 f[] Yes ❑ No Condition: Does side sewer have al least 1% slope from the building to sewer main9 �Yes ❑ No Describe: Have all building sewer drain connections lo lhe side sewer been identified and located7 k] Yes ❑ No Have all property starm drainage connections to the side sewer been iden6fed and tocated7 [� Yes ❑ No Has property been evalualed for drainage deficiencies a�ilh findings communicated to property owne�l ,� Yes ❑ No Inslallation Details What type and brand of BWD was installed at ihis sit Clean Check B rinder pump, etc.): Where was Ihe device installed (general descriplion, attach map)? ��5, ��F ��'�v�• w� r c�-I� ^�+-� < ! c �t'i Was there any other sewer or storm drainage work completed in wnjunction with the BWD work? Is so piease describe: _ Installatian Checklist: Are all downspouts and site drainage disconnected irom upslream ot lhe BWD7. {�Yes ❑ No Commenls: Does BWD pasiGo;iing meets minimum slope requirement o(>1%7 �Yes ❑ No Commenls: Can BWD be pulled oul for irspecGon and mainlenance after loosening ihumb screw? �[/] Yes ❑ No Is BWD locked into the proper ?osition and ihum6 screw tight� ned? Yes ['i No Circle the BWD cover: irrigaGon cover (landscape area) / tr�oa eanng cover ( nve surfac • access hatch (building) Was property owner shown the localion ot the installed BWD9 � fes No Comments: Property Owners Signalur : •� ��-! '� �%�-'�-� Date: � � -r Inslallers Signature: , � Date: ��%�/ �� Revision: 2 1 Friday, September 12, 2014