3701 ROCKEFELLER AVE 2022-05-12 - Laserfiche WebLink

� � ��.C�4�i4'Rei�R PREVENTB�Of� DEV�IC� FIl�AL I�1ST'AL�A�"{ON CFiEGKLIST Instal!ation Company �'ame and Conta� �nfo: _M ��-�� I�i� �� •� y �� S—]�U — K 3� c Dale 82ck�:ater Frevention device (BVJD) �.vas instailetl: s—� � � S __ Date ihis fo�zn was r,ompleted:�— G—1 S� InstallaiionProperty0�vnert4ameandCont2ctinic �k 30.-� Q6 h"ro a� `{�� rf S 17 6 Propery Address: �� iZ b�k e�-c 1 lQ,� /�}u ` Pre-Installation Inspection Checklist: All ifems must be cnecked '1'es'in order for a BVJD to 6e considered forinstallalion is there a 6asement or Ievel o( the house tnat is at or near ass�med setiver main elevaiion? �f Yes ❑ PJo Are there fix;ures in ,he nouse located belo�v the upstream sewer manhole rim e!evaiion? � I 1'es [' Nc Is the side sewer currenY,'y U\�PROTECTED from sevrer bac<uos (dces no� have a BI�dD instailed)? [�Yes ❑ No Site Inspection Checklist: �ll ri�.ms must be checlred 'Yes' before inspection is considerad complefe 41�as side see:er TV inspscted from building to serrer main? � Yes ❑ No Ccndition: �rov �. Does side sewer have at ieast 1% slope from the buitding to sev:er main? j�] Yes ❑ Nc Descri6e: Have zll bwlding se�ver drain cennections to the side se��;er been identiFed and Iocated? �,Sl Yes ❑ �do Ha��e all pr�periy storm drainage connec,ions to the sitle se�ver oeen identified and located? ,�i Yas ❑\o Has property been evaluated for drainage d.ficiencies e�ith findings communicafed to properiy o�;�ner? �l'es ❑ IJo Installafion Detalis: 14�hat tyce and brantl of aWD �;�as inslalied al this sife (Clean Check 9l'JV, Grintler eump, etc.}: C�tc>� c�,c/� 14mere was Ihe device inslalled (general descnption, attach map)? �� ck o�� Gic'l4SC_ S� c�,�,�/ l�Jas there any other setezr or slorm drainage u�ork comoleted in conjunction u�ith the 84ND tvork7 Is �o plzase tlescribe: �« InstaliaEion Cliecklist: Are all doevnspou�s and sile drainage disconnected irom upstream of the BWD? � Yes ❑ No Commen�s: Dnes BVdD posiiioning meefs minimum slope requirement of >1%? [�] Yes ❑ No Comments: Can Bl'VD be puiled oul for inspection and maintenance after loosening ihumb scre�v? � Yes ❑ P10 Is B�A'D locked into the proper position and tfiumb screw tightened? }� Yes ❑ ho Circle lhe BN�D cover.` alion c�� landscape area) /traffic load bearing co��er (drive sur(ace) f access hatch (building) 1r�las prcperty owner sho�,�n the location of the installed BIND? �] Yes ❑ No Comments: Property Owner's 5ignature: Dale: Ins(allersSignature: �'� ��—' Date: S 6��5 Revision� 2 ? Ivlonday, September 15, 20?4