2621 ROCKEFELLER AVE 2022-05-12 - Laserfiche WebLink

BACKWATER PREVENTION DEVICE FINAL INSTALLATION CHECKLIST 7',U z.CoN(�'ac{-avs � r.,�, c. Inslallalion Company Name and Contact Info: fe✓¢m�� MU��.w►^ 3�� -�I -g�s r T�e Z(a 6 Date Backwater Prevention device (BUVD) was installed:�� Y�Miu ��'S ��Dafe this fonn was completed: ��' G- /S Installation Propert� Owner Name and Contact Info: Sha.wNa Z/a h r�{ZS - 9?I - 67 � 7 Propeny Htldress: 2 G 2 Pre•Installation Inspection Checklist: Alf items must be cliecked 'Yes' in order for a BIND to be considered for installaticn Is lhere a basement or level of the house that is at or near assumed sewer main elevation? t�j Yes ❑ No Are [here 6xtures in the house loca�ed below the upstream sewer manhole rim �levation? � Yes ❑ No is the side ser+er currenUy UNPROTECTED from sewer backups (does not have a BWD installed)? � Yes ❑ No Site Inspection Checklist: All items must 6e checked 'Yes' before inspection is considered complete Was side sev�er ?V inspected ►rom building to sewer mainl �-Yes ❑ No Condition: (� �� _ Does side sewer have at least 1% slope from the building to se�ver main? � Yes ❑ No Describe: Z`�n Have all building seeier drain connections to the side setver been identified and locate�? .Q Yes ❑ No Have all property storm drainage connections to the side sewer been ideniifed and located? {�.Yes ❑ No Has property been evaluated for drainage deficiencies e�ith findings communicated to property owner? � Yes ❑ No Installation Details: What type and brand oi BWD was installed at lhis site lean Check.BVW, Grinder pump, etc.): C��EM C�t Pe�r `f " Where was the tlevice installed (general description, attach map)? /t'l�f� �'l��t'l�Fr� /pfr�+��Rc��'1�� /r�!'�r, l`•i �. �, �l ' �fv �e�,�c/' ma �� DrcP Was there any other sev,�er or storm dr2inage �vork completed in conjunction wilh ihe BWD work? Is so plcasc describe: _ l�hl�cOnF�i 'i��SYw�l �,��2 P-�l'ouifP'�i��.i�li1SPlukSf�� U;1e-, C'o-�;�P-fe_��:rdeLr• Installation Checklist: Are all downspouts and site drainage disconner.ted irom upstream of the BNlD? ❑ Yes ❑ No Comments: Does BWD positioning meets minimwn slope requirement of >1°0? ❑ Yes ❑ No Comments. _ Czn BWD be pulled out for in�pection and maintenance atter loosening thumb screev7 ❑ Yes ❑ No Is BWD locked inlo the proper position and ihumb screv,� �igMened? ❑ Yes ❑ No Cirde the BWD cove irrigation cov landscaQe area) traffir, Inar+ h�rrnn mver (drive s�rface)1 access hatch (building) Was property owner shov��n lhe localion of Ihe installed BV1'U! j'I� Yes U No Property O�vner's Signature: �/%lP.u.T1� � �!✓I'� Insfallers Signa!ure: ��i�_ Comments Date: %� '� �� Date: /�- -/� Revision: 2 1 Friday, Septemher 12, 2014 OS