2613 ROCKEFELLER AVE 2022-05-12 - Laserfiche WebLink

� � BACKWATEf2 PREVENTION DEVICE FINAL IiJSTALLATION CHECKI.IST TeY¢mY M019nY13G0-391-Szs f Installation Company Name ar.d Cortact Info:TM�. C�n+'r4d'ar5, LC.G 3�De Zlab 425-8�6-73�5 Dale Back�:ater Prevention device (B�VD) was installetl:�l-'1 4+�n� ��- 5 Date lhis torm was completed, 1�- E' � S Installation Property Owner Name and Conlact In(o: ��a..uv�a ?(u b 425-97l-L�?f'7 PropertyAddress: 26 �3 2c�1��1�/-�vz., Fve��'it (✓A 9�<<'I Pre•Installation Inspection Checklist: All rtems must be checked 'Yes' in order (or a BbVD to be considered for insfallation Is lhere a basement or level of the house that is at or near assumed se�xer main elev2tion? [R Yes ❑ No Are Ihere fixtures in ihe house located below the uostream sevrer manhole rim elevation7 Q Yes ❑ No Is the side se�+,er currently UNPP.OTECTED from sev�er backups (does nol havz a BWD instalied)? � Yes ❑ Mo Site Inspection Checklist: All rtems must be checked 'Yes' 6e�or? inspection is considered compfetc lNas side se�•�er TV inspected fwm building lo sev�er main? � Yes ❑ �:o Condition: (� � Does side sev+er have at le2st 1% slope frem the building to ser,er main? j� Yes ❑ No Descrihe: ?� Have alI building sewer drain conrections to the side seu�er been identified and located? ❑X Yes ❑ No Have all property storm drainage connections to the side se�.ver been �dentifietl and located? (�j Yes ❑ No Has oroperty been evaluated tor drainage deficiencies ivith (indings communicated to property owner? k[1 Yes ❑ No Installation Details: What type and brand o( BWD was installed at this sit Clean Chec BVW, Grinder pump, etc.): ��''�^ � ti�'t�t `� � INhere �vas the device installed (general descnption, aUach map)? ✓�1 Qi� /�H��/�.pd 1 � s'� [.�P v�i� � P�we.� �61� Q'�(� ZG �S (�ccl�r/P/l�r,f� S 6��ro�-+ rJ��o �o sP��e/' Mn.`n, Was lhere any other sewer or storm drainage v:ork comp!eted in conjunction e+ith the 8WD worl:? Is so please describe: _ u�. Installation Checklist: Are all downspouts and site drainage disconner,ted from upslream of ihe BWD? �C Yes ❑ No Comments: Dces BWD positioning meets minimum slope requirement of >1 °o? (� Yes ❑ No Comments: Can BIND be pul!ed out (or inspection and maintenance a(ter loosening thumb screv+? � Yes ❑ No Is Bb�'D lucked into Ihe pro er osilion and ihumb scre�v tigh�ened? � Yes ❑ No Circle lhe BWD cove irri ation cover (lantlscape a� / iraffic load bearing cover (drive surface) I access halch (building) Was property owner shovm the location of the installed 6WD? �C] Yes ❑ No Commenls: __ Property Oa�ner's Signature y,4 �/� Dale: �!'� -1 S __ Installer's Signature: _`�t�_�i l� Dale: I I- G- �S U lJ Revision� 2 1 Friday, Sep[ember 12, 2014