3507 OAKES AVE 2022-05-04 - Laserfiche WebLink

BACKWATER PREVE14TION DEVICE FINAL d _n- INSTALLATION CHECKLIST Installation Company Name and Contact Info: Mor_A 10/k ter%%rq U'), S - 760 - Date Backwater Prevention device (BWD) was installed: 2- 9-- I S V Date this form was completed: ,Z- `7-1S Installation Property Owner Name and Contact Into: ,To.AX S_ y Property Address: 3 S U'V vc k t flt.c- I; e, elit UA GSS' d k Pre installation Inspection Checklist: All items must be checked 'Yes' in order for a Blr✓D to be considered for installation Is there abasement or level of file house that is at or near assumed sewer main elevation? Q Yes ❑ No Are there fixtures in the house located below the upstream sewer manhole rim elevation? ® Yes ❑ No Is the side sewer currently UNPROTECTED from sewer backups (does not have a BWD installed)? © Yes ❑ No Site Inspection Checklist: All items must be checked 'Yes' before inspection is considered complete Was side sewer TV inspected from building to sewer main? E Yes []No Condition: C-L% C-wi Does side sewer have at least 1% slope from the building to server main? ® Yes ❑ No Describe: nc A : ai Have all building sewer drain connections to the side sewer been identified and located? E'Yes ❑ No Have all property storm drainage connections to the side sewer been identified and located? [�J Yes []No Has property been evaluated for drainage deficiencies with findings communicated to property owner? YYes ❑ No Installation Details: What type and grand of BWD was installed at this site (Clean Check BWV, Grinder ;, mp, etc.): C It'c n C mac. k Where was the device installed (general description, attach map)? I?C c k vc , 3 Was there any other sewer or storm drainage work completed in conjunction with the MID work? Is so please describe: Installation Checklist: Are all downspouts and site drainage disconnected from upstream of the BWD? (Yes ❑ No Comments: Does BWD positioning meets minimum slope requirement of >190? E] Yes ❑ No Comments: Can BWD be pulled out for Inspection and maintenance after loosening thumb screve? ®Yes [:]No Is BWD locked into the proper position and thumbscrew tightened? NrYes ❑ No Circle the B1k1D cover: rrigation cove landscape area) I traffic load bearing cover (drive surface) I access hatch (building) Was property owner shown the location of the installed BWD? L5j Yes ❑ No Comments: Property Owner's Signature: Date: Installer's Signature: _�_ 1t �— Date: Revision: 2 1 Monday, September 15, 2014