1619 LOMBARD AVE 2022-04-29 - Laserfiche WebLink

� - � BAQ;KW'ATER PREVENTION DEVICE FINAL E� IINSTALLATION CHECKLIST , (� Ins(alia(ion Ccmpany Name and Contact Info: ,��r1'\ i r�� Lt�S t��- v�1�i5 i,��G, ��,�( : Date Back�valr,r Pre��eniinn device (BWD)vdas installed: S I �5 Dale this (orm tv�s com leted. C`(3� � S —� P � Insial!a(ion Property Owner Name and Contact Info: {Ma,r k 2�� `-1Z-5- 2i�-" 9� �Z r roperty Address: _�(Qlq��o� �arc�_��---- ` Pre-Installation inspection Ciiecklist: F.II i;em� rrust he checked 'Ves'rn nrder ior a QIND!o be considered fot installalion !s (I•.ere a besement or level of the house�hat is at or near assumed se�a�er main elevat�on? [�]Yes L� No Are there fixfures in tne house lor,ated'ueloev ihe upstream sewer manhole rim elevation? �� Yes ❑ No, Is ihe;ide se��rer�urrentiy UNPRGTFCTED(rom ser�er backups (does not have a f34UD ins(aUedj? �� ❑ ;,�� Site Inspection Checklist: Afl items musl be r,hecked 'Yes'before inspection is considered complete v<<as side sevier N inspecled from building to sev,�er main? � Yes ❑ N�fidi(ion: _ Does side se,ver have a� least 1'L,slope from Ihe building to sewer main? [ Yes ❑ IJo D scribe: Nave ali huilding sevaer drain connections io the side setiver been idenliiied and located? [�es �o Nave all property slor: ;drainage connecfions to the side sewer been identiTied antl located? [� Yes ❑j Flas property.baen evaluatetl (or draina ge defir.ien�ies with f in din g s c o m m u n i c a t e d t o p ro ps r t y o w n e r? [� `(e s ❑ N o Installation Details: 1�1'hat (ype and brand oi BWD was installed at lhis site (Clean Check BINV, Grinder pump, etc.): _��.e.a,n E�ie.� 1^lhere�vas Ihe devir.e instal�ed (general descrip(ion, a�iach map)'? _ ��ak y a.-c/ — ,v o�}-1.=,s,c{� �,��•,a„s� 1Nzc lhere any olher sev�er or storm drainage��urk completed in conjun�lion with the BWD work? Is so please descriCe: r�o Installalion Checklist: � Are all downspouts and siie drainaye disconnecled Irom upstream o!the BWD? (��es ❑ No Commenis. _ Dor.s BWD posilioning meets minimum slope requiremenl of>1%? [�Yes ❑ No Commenfs: Can RN1U bepulled out for inspeclion and maintenance af(er loosening Ihu b screv�l �Yes ❑ No � Is UWD lor,ked into the proper position and thumb screw tightened? Yes ❑ No C!rcle thr. HWD cover: i��tllan�/d�sc pe a�ea)/lraffic load b aring cover(drive suriace)!access hatch (building) !�das preperty:o�vner sho�n�n ihe la�tior,of the installed l3N/U? .:_ Yes r I �J� Comments: Fropeity O�vner's Signalure;_ f� �- � � �L � Dafe: 5 — 1 Z. •- �s Insfaller's Signatufe:_ �� Date: /3 �-c� �5 ��--- -- -5-�--�----- Rrvision: J � 1 Mnnday, Septemher lti 7f�i.i