3407 GRAND AVE 2022-04-18 - Laserfiche WebLink

BACKWATER PREVENTiON DEViCE FINAL INSTALLATION CHECKLIST Installadon Company Name and Contact Info: M ��n (�IuN,h%n� `I ,Z S� Date Backwater Preventbn device (BWD) was installed: �� '� S- Iy � Date this form was completad: ��' 7v -�4 Installation Property Owner Name and Contact Inio: k�� f a D4� .� �� S;� �i (, Property Address: '`'i U 7 (,�vc.� �- /h.t 5F C—v�ne. H w h ti sr a � i Pre-instelletlon Inspection Checkiist: All items must 6e checked'Yes' in order for a BWD to be considered for installation Is there a basement or level of the house that is at or near assumed sewer main elevation? � Yes ❑ No Are there fixtures in the house located below the upstream sewer manhole rim elevation? � Yes ❑ No Is the side sewer currenUy UNPROTECTED from sewer backups (dces not have a BWD Installed)? ❑X Yes ❑ No Site Inspection Checklist: All items must be checked Nes' before inspection is considered complete Was side sewer N inspected from building to sewer main? � Yes ❑ No CondiBon: C�� e- Does side sewer have at least 1% slope from the building to sewer main? � Yes ❑ No Describe: Have ail building sewer drain ocmnections to the side sewer been idantified and lorated? � Yes ❑ No Have all property storm drainage connections to lhe side sewer been idenGfied end located7 ❑X Yes ❑ No Has property been evaluated far drainage deficiencias with findings communicated to property owne�t � Yes ❑ No InatallaHon Detalls: What type and brand of 8WD was installed at this site (Clean Check B1NV, Grinder pump, etc.): G �� c.� c%,,� � i� Where was the devioe i�stalled (general descripkon, ariach map)7 (� c ti � h Z I� o�. sc I—rfi� ,�'wcti �. a� )'�. R' ii 'ik iivr', ^,� fn,�y,,�'�Y ��-�-- Was therepny other sewer or stortn drainage work completed in conjunction with the BWD work? Is so please desctibe: _ Installatlon Checklist: Are all downspouts and stte drainage disconnected from upslream of the BW01 0 Yes ❑ IJo Comments: Uces BWD positioning meets minirnum slope requirement of >1�oT � Yes ❑ No Comments: Can BWD be pulled out for inspecBon and maintenance after loosening thumb screvJ? e Yes ❑ No Is BWD locked Into the proper posilion and thumb sc�ew tightened? � Yes ❑ No Cfrcl= the BWU cover. rrigaUon oover ndscepe area) f haffic load bearing cover (drive surface)1 access hatch (building) Was property owner shown the location of the Inst�lled BWD'T � Yes ❑ No Comments: Property Owner's Signalure: Date: Installers Signature: ��.� ��y`-�--y-'— Date: � �' � 0-' � L� Revision: 2 1 Monday, September 15, 2014 \