2302 PINE ST 2022-05-04 - Laserfiche WebLink

� �---� - _ ; BACKWATER PR��O€NTOON �EVICE FlNAL Q, INSTALL.ATIOiU Ch1�CKLI�T :�i:FF-I- r_,�n� � ��.e;�,. Installalion Company IJame and Conlaci Info:�Yl('�-�[�iLi.�'�'� `M' `��' ��'�'v�d-<<-�•�� `��.Y:� Dafe daekwater Prevenlion device(BWD)was installed:�j�1c�_Dale Ihis form�vas completed: � SC i� _ Inslallalion Nropedy Owner Name and Conlact info:�-�'� �Kn 1•r.t Qr• h<%,�C��t� �+— ` � �3l-.--- ProperlyAddress:_�:�'_-�� 1''i Y1P_ `'r�� t�o^frr�' ��:Z[71 Pre•Installation Inspection Checklist: , A11 items must be checked'Yes'in order for a BWD fo be r.onsidered/orinsla!lalion Is Ihr.rr,a basement or level of Ihe house thaf is at or near assumed sewer main elovalion?(1�Yes ❑No Are ihere fixtures in tlie house located uelow lhe upstream se�ver manhole rim elevalion7�Yes ❑ No Is Ihe side sewer currently UNPROTECIED(rom sewer backups(does not have a 8WD installed)?�Yes ❑No Site Inspection Checiclist: All items rnusl 6e chedced'Yes'6e(ore inspection is considered complete ' Was side se�ver TV inspecled irom building to sewer main? ?�J'. Yes �-]No Condition:��,�'" _ � �oes side se�ver have at laasl 1%slnpe from the buifding lo sewer main? [�,Yes ❑No Describe: Have all building sewer drain conneclions to the side sev�er been idenlified and localed? QYes ❑No Have ail property storm drainage cronnections to Ihe side sewer been itlentified and laafetl? ��Yes ❑ No Has propedy been evaluated for drainage deficieneies with findings communicated lo property owner? �Yes ❑No Installation Details: � What type and brand of�WD was inslalled at this site(Clean Check BWV,Grinder pump,etc.j:�p��v�` ��r"�c�i Wherr,tvas Ihe device inslalled(gene�al descripGon,attach map)? __��(, (' ' ' �r ' S t�!L�=l= Was Ihere any olher sewer or slorm drainaye work compleled in conjunclion with lhe DWD tvork?Is so please describe:_ f�a`Yt_�-- -- -- � --- -- � Instailation Checklist: � Are all downspouls and site drainage tlisconneeted fmm upsircam of iho OWD? [��Yes [�No Commenls:__.__ i Does BWD posilioning meets minimnm slope requiri:ment of>1%7 �Yes []No Commenls:.__ � Can BWII be pulled oul fnr inspr,slion and mainlenance after laosening Ihumb screw? �l'es ❑No Is BWD bcked inla Ihe proper position and thumh scre�v lighlened? �f Yes ❑ No Circle lhe BWD covu IirigE aliori cover landscape area)I Iraffic Ioatl bearing cover(drive suriace)I access hatch(building) Was prepeity ovmer shown Ihe tocalion of the inslalled S;ND7 [�Yes ❑No Commenis: Property Owner's Signalure: \ ` __�_ Date: �'��9 �� Installer's Siynature:_ V� I/1�.�-1' _ Date: � � �� ( v 1 Friday,Sep[embcr 12,2014 � lievision:2 • .. ._.. . _ . . _ _ ..- - - - ._ _ i I - -- -- ---'. '-- �--- � --- - �-- - i I