1709 HOYT AVE 2022-04-19 - Laserfiche WebLink

; I ��C��aT�� E��TlE�f� �EV6�E �1�6Af� ; �PJS��L�.A3'[�� °I�.C!(L.IS� ; � Installation Company Name and Cantacf Infa "��r7'�� %�J � �� - ��Z 3 � Date Backv�ater PrevenHon device(BWD)�vas inslalled: �o-!� - l 5� Dale this fortn was completed: G��/S� S � i Inslallation Property Owner Name and Contact Info:1�y�-�e�'� ��-"^I�^- Property Address: �� -�� — �Z2T~ �i PrQ•tns4ailafion Inspection C.hechlist: � All ifems must be checked`Yes'in order for a BIND to be considered for insfaflation � Is there a basement or level of lhe house that is at or near assumed sewer main elevation7 �X2s ❑No Are there fixtures in fhe house lo�ated below the upsheam sewer manhole rim eleva6on?0�'e"s ❑No i Is ihe side sevrer currenUy UNPROTECTED from sewer backups Idoes not have a BWD installed)?[�-YEs ❑No � Site Inspection Chect;list: � /lll items musl tte checked'Ves'be%r�inspeciron is considered camplete � Was side se�ver TV inspected from building to sewer main? ��es ❑No Condilion:��' ��Q- � �`I `• Does side sewer have at least 1%slope from ihe building to se�ver main? []Xes ❑No Descn : i Have all building sewer drain connecfions to ihe side sewer been i�entitied and located? �� ❑No ; Have all propedy storm drainage comiections tc the side sewer t�:en identified and located? Q.Xes []No � H,s property been evalualed for drainage deficiencies with findings communicated to property owneR �1�-Yes ❑No installation DeWils: n � : What type and brand of BWD wss insfalled at this site (Clean Checic BW�V,Gnnder pump,etc.): ��C �-�--�`�� t Where was the device inslafled.(rg�es�Jerpal d�esCOription, atlaGh map� �`i:��>^-`�Lr � J �-r'��`"e-`�T` 1-Y(!�lJIX—(/� �� .�11�N 0 c.l�� Y' - _ i L 1 Was Ihere any other sewer or stomi drainage worlc compl I d in conjunclion wdh the Bb'JD work? Is so please descrihe:__ I -� ��(T"-Q_ � �.—_ ' _ � 6nstafla4ion Checklisf: i Are all downspouts and site drainage disconnected irom upytream of the BWD? es ❑No Comments: ; Dces BWD posiUoning meels minimum slope i�quirement of>1%? []�-1'E� 0 No Commenis � � Can BWD be pclletl out tor inspec6on and maintenance after loosening thumb screw? [�'es ❑ No � Is BWD locked into ihe pmper position�nd`iwttrtrsefe��ightened7 �es ❑No � Circle the BWD cover: imgation�ver_(landscape 3rea)/)laffic load heanng cover(drive suriace)1 access hatch(buildingj VJas property otivner shown ihe IocaGon ofifs-e'iqs�_+Iled BWD? [�].Yes-[]No Commenls:_ ._..� ---� �, Pmperty 0�vner's Signal�re: C r?�7�L��- Dale: �-� '� -� 5~ � �� CE, -/ S�- �S.� Inslaller's Signalure: . Date: Revision: 2 ] Friday,September 12,2014