1011 HOYT AVE 2022-04-19 - Laserfiche WebLink

! ; �A�I��.�'�R PR�V�t��cC�i� ��1/ICE FINe4L � , 9�STA�LATlOV� �64ECl��.i�`� I � � Installation Company Name and Contact Info: /v��i;� I�,h,�,�L,.l �(,�S 7G U S 3 G � _ � Date 6ack�vafer Prevention device(BWD)was installed: �3-3��S Dale this form was compleled: -�-�y-�t� ! Installation Prope�ty Ov+ner Name and Contact Info: I�� 'r;�, �c,-, '-1�S - 30 3 - i I U 6 ! � PropertyAddress: "��'" I � ll �-fbv � /�-� ��-cr'�;}l �11 S.r7u� � � Pre-Installation Inspection Checklist: Alf ilems must be checked`Yes'in order for a BWD to be coosrdered(orinstallation ! Is there a basement or levei of the house ihat is at or near assumetl sewer main elevation7�Yes ❑No i Are there flxtures in lhe house localed below Ihe upstream se�ti�er manhole rim elevation? �Yes ❑ No ' Is ihe side sewer currenlly UNPROTECTED from sewer backups (does noi have a BN�D installed}?�Yes ❑No � Slfe Inspection Checklist: � (� � ��lo (YKtOi � (� Gccc�� ¢v Afl items must be checked'Yes'betore inspecfion is considered r.ompfete ��.��y' �t��k�} cw-ci �/�^<-• Was side sewer T1�inspected fmm building lo sev✓er maln% 0 Yes ❑ No Condition: � Does side sewer have at least 1°/a slope from the building to sewer main? ❑Yes ❑�o �escribe: _ i Have all buildinc�szwer drain oonneclions lo ihe side sewer bean idenlilied and located? Q Yes ❑IJo � Have all property storm drainage conneclions to the side sewer been itlentified and located7 ��Yes ❑ No ; Has properly been evaluated fordrainage deficiencies v�ith findings communicated to properiy owner? d Yes ❑No i Instailation Detaiis: What type and brand ef DWD was installed at ttiis site(Clean Check aWV, Grinder pump, etc.): C��n 0�c C 4 Wheie was the device installed(general descriplion, attach map). I n " J � LC � ��o S;.-<<c ,k l.-,cr�...�- E �,M,; � � � i . 35 there any other sewer or stonn drainage�vork compietetl in conjunclion vrilh the �IVD v,ork. Is so please descri�e:_ � _ ------ � Installation Checiclist: ' Are all davns ouls and site draina �disconnected from u stream oi Ihe BWD? Yes � p ,y p �� ❑No CommeNs� � Does BWD posltloning meets minimum slope requiremenl of>1%? �Yes ❑No Commenis: � Can BWD be pulled oul(or inspeclion and mainlenance after looseniny Ihumb screw? _]-Yes-�-No— � Is BWD locked into the proper position and thum6 screw tigh;ened? [�Yr.s-e-�ltr Circie lhe BWD cover: irrigation r,over(lantlscape area)1 traific load bearing cuver(drive surface)��SS hatch_(builtlirg) VJas property o�vner shown the location of Ihe inslalied BWD7 �Yes ❑ No Commenls: � I Properiy Owner's Signature: Date: � Inslaller's Signafuro: �,�-�1 ,��•�---- Date: ' ; i t:�evision:� 1 Monday,September 15,201A i j