1605 HOYT AVE 2022-04-19 - Laserfiche WebLink

BACKWATEF2 PREVl:NTIOi� DEVICE FiNAL INSTALLATION CIiECKLISl' installation Company Name antl Contaci Inio:/ !�,sc(��oi�'ss�ur�,`7�a'�� '' �v �i�.�` ��l�� Date Back��aater Prevention de,rfce(BWD)!vas installed_� ` � �� _Date this form was comp!eted: 3—�i- �+-%<. _ Installation Property Oi�mer Name and Contacl Info:,"�ct l 'f��'-� � ��S "" �s8 ' �%'�/ — G�S �-f� f �,� ��u��, ,c�Q. �� > Propeny Atldress: I � Pre-Installation Inspe:tion Checklist: All ifems musf be checked'Yes'in crder lor a AWD to be considered(a instalfation �s there a basemert cr level of the house ihat is at or n=ar assumed s2v,er main e!evation?�Yes ❑ No Hrp there rixtures in the hou�e lo�ated below lhe upstream sce�er manhole rim elevahon? �'Yes ❑ No Is the side sevrer currenlly UNPROTECTED irnm se�ver backups (does net have a Blh'D insfal!ed)? (�}Yes ❑ IJo Site Inspection Checkiist: All items must be checked 'Yes'be!ore inspection;s considered complefe � V�'as side sewer TV inspected from building to sewer mzin? �Yes ❑ No Condition: � '�� Does side sevier have al leasf 1%slope from the building to sevrer main? �Yes ❑ A'o Describe: Ha�re all building setver drin r,onne�l�ons to the side se�r+er been identifietl and located7 �1'es ❑ tJo Have all property storm tlrainage connections to the sitle sewer 6een identified and located? �+' Yes ❑ No Has pmperty heen evalualed(or drainage de(icien�ies tvith findings communicated to properiy o��.ner? �Yes ❑ No � lnstallation Details: l--, n f l'Jhat type and hrantl o(BWD tivas instai:ed at this site Glean Ch-�BtN1�, Grinder um ,etc. : I'��'1�f r'�� '''� : 1P P ) -- 1Nhere was the devi�e installed(general descrip�ion, atiach rap)? �r+��: Y�-I�` �✓1T !.i /,��,,��'<� � 1'das there any oU�er se':eer or slorm drainage wor�completed in conjunciion��ifh ihe QWD�t�ork? Is so,lease desrrihe:�Q Installation Checklist: Are all doa�mspouts and sile drainage disconnected from upsVeam of Ihe BW�? � Yes ❑No Commenls: Does BI��D positioning meets minimum slope requirement o(>1°�fi? � Yes ❑Nn Ccmments: Can B\ND be pul!etl oui(or insp�cGon and maintenance after loosening thumb screw? '�Yes ❑No Is B14'D locked into the proper posilion and thumb scre�v tightened? �Yes ❑No Circle the BWD cover: irrigation cover landscape an:a I traffic ioad bearing cover(drivz su�`ace) 'access halch (building) 6'Jas preperiy ovmer shorm the lo;etion o o inslalled B'vUD? �]Yes ❑No Commenls:__ Property Owner's Slgnature�. ''`�'�� 1 _ Dale: � � �� ' ��f��5 ' �,i— • �-- Installer's Signature: V� ��'��-�� 7i�!-Lt� Date: 3�q'�c��5 t. ` � Revision: 2 1 �4onday,September 15,2074 '�