3817 HOYT AVE 2022-04-29 - Laserfiche WebLink

� �ACKVJk'ATER PREVENTION �EVlCE F�NAL INSTALLATIaN CHECKLIST Inst�ilation Company Name znd Contact Info: /� �Nc� l�/v/� /3%n� Date Back�vater Prevention dev�ce (BWD) was Installed: z/�3// S�Date this form �v2s completed: Z 2�%�/S' Inslallation Prcperty Owrier Name and Contact Inio:.^'�G'I' S54 � n Ve Sr� �'n -!S Property Aodress: � 4/7 /-�c vf !1 �C — Pre•Installatian Ins�iection Checklisl: ,411 items must be checked 'Yes' in order lora 84VD fo be considered torinstallalion Is there a baseme!�t or level of thc house thal is at w near assumed sewer main elevation� Yes ❑ No Are lhere 6xlures in the house located belov� the upstream sevier manhcle nm elevation? Yes ❑ No Is the side sewer currently UNPROTECTED irom se�ver backups (daes not have a BNlD installed)?�] Yes ❑ No Site Inspectiun Checklfst: All items musf be checked 'Yes' before inspecfion is considered c on�plefe Was side sewer N inspected from buiiding to sewer main9 � Yes ❑ No Condition: Does side sewer have at least 190 slope (rom lhe building lo sewer main? �f] Yes ❑ No Descri6e: Fiave all building setver drain c„nnections to !he side sewer been idenli5ed and looaled? 0 Yes ❑ No Have ail properfy slorm drainage conneclions to the side sewei b�:en identifed and localed? /�] Yes ❑ No Has property been evaluated (or drainage defcienoes �vith fndings communicaled to property owner� �] Yes ❑ No Installation Details: What type and brand of BWD was installed at th� i e" lean �k a, nnder pump, etc.): _ Where was Ihe device installed �general descriplion, attach map)? B�� Gy h��• sr' o" -- SCo.na G - r . / . NJas lhere any olhe.r setver or slorm drainage work completed in conjur,slion wilh Ihe BIND vrork7 Is so p!ease descri�e: _ Insfailation Checklist: Are all �iownspouts and site drainage disconnecled from upslream o( the BWD? � Yes ❑ No Comments: Uoes BWD positioni�g meets minimum slope requiremenl of >1°h7 [Zj Yes ❑ No Comnients: Can BWD be pulled out for inspec�on and maintenance after lo�sening lhumb scre�� ,� Yes ❑ No Is BN'D locked ir.to the proaer posilion and` thum� tighlened? �'1 Yes ❑ No Circle the BWD covet}itng,�['ion cover (landscape area 'traPic load bearing cover (drive surface) I access halch (building) Was property owner shown the localion ��h�n�ta�l d BWfJ? �] Yes ❑ No Commenls: _ Property Owners Installe�s Date: _�,Li 7�'� Date: 2/,'%l �-� Revision: 2 � 1 Friday, Sep[em6er 1�, 2014