2409 ROCKEFELLER AVE 2022-05-11 - Laserfiche WebLink

t BACKVV►fATER PREVEAITION DEVlCE FtNAL INSTALLAI'ION CHECKLIST Insfallation Company Name and Contact Info: M�z�� I��Hr^�� y y� i— 7(,U —� 3� c Dale Backwafer Prevention device (BWD) was instailed: S� �($� Date tfiis iorm wae mmpleted: S�� "� S Installation Property Owner Name and Contact Info: S� ^.�� U� r I 1 sU v �`� i� �i � i✓3U�1 Property� Address: _�-L( Ci �% 2�� c f� �d�e ��-i �� Pre-Installation Inspection Cheaklist: AIf items must be checl;ed'Yes' in order for a BtND to be considered forinstallaUon Is there a basemenl or level oi the house lhat is at or near assumed se�eer main elevaiion? Q Yes ❑ Plo Are ihere fixtures in the house located below �he upslream sewer manhole nm elevalion? [J Yes ❑ No Is the side se�ver currently UNPROTECTED from setiver hackups (does not have � BN�D installed)7 [� Yes ❑ IJo 51te Inspection Checklisf: AAitems must be checked'Yes' before inspection is cansidered complefe VJas slde sewer N inspecled from building to sewer mainl �] Yes ❑ No Condition: �/D �V� Does side sev,�er have at least i°/a slope from the building to sewer main? � Yes ❑ No Describe: I-iave aii bullding sevder drain connections to the side sevrer been identified and located? � Yes ❑ No liave all property stortn drainage conneciions io the side sewer been identified and located7 �S Yes ❑ No Has proper�y been evatuated for drainage deiiciencies v+ith findings communicaled (o properiy owner? (�} Yes ❑ No listallation Details: 4Nhal type and brand oi BWD was ins(alled at this sife (Cleai! Check BWV, Grinder pump, etc.): I`�i c-�e �.li ✓r�tvt- l4mere �vas the devlee Installed (general description, atiach map)? �..�' _ Was Ihere any other sev,�er or storm drainage vaork compieted in r,onjunr,tlon wlfh tne BWD work? Is so please describo: _ _ �L�� Installation ChecklisE: An; all downspouts and site drainage disconnected irom upstream of ihe BVt�D? �Yes ❑ No Comments: Ooes BIND positioning meeis minimum slope requirement of >1"/0? �( Yes ❑ No Commenis: Can BWD be pulled out for inspection and maintenance after loosening Ihumb screw? ❑ Yes ❑ Nc Is 4WD locketl into lhe proper posilion and ll�umb screw lightened7 ❑ Yes ❑ �o Circle the BWD eover: irriga6on cover pandscape arna) I ira�r, load bearing cover (drive surface)/ access halch (building) Was property o�aner shown the localion oi lhe insialled 8WD'? �Yes ❑ No Comments: Propany Oveners Signature: Date: Insiailers Signalure: ��' `— , ,,.. `��. Date: S ' fi' � ( S'� Revision: 2 1 Monday, September 15, 2014