1528 RUCKER AVE 2022-05-12 - Laserfiche WebLink

BACKWATER PREVE�VTION DEVICE FINAL INSTALLATION CHECKLIST Installalion Company Name and Contaot Info:A+ S�wer TPchnologie5l 1 C (A88-213-76 61 � Date backwater device(BWD)was inslalled:_ Date Ihis form was completed: Instalialion Property Owner Name and Contact Info: Chuck Steinberner 425 239•4346 Property Address: 1528 Rucker Ave Everett WA 98201 Pre•Installation Inspection Checklist: All items must 6e checked 'Yes'in order tor a BWD lo be considered for installation Is there a basement or level of the house Ihal is at or near assumed sewer main elevation?[�Yes ❑ No Are Ihere fixtures in ihe house located below the upslream sewer manhole rim elevalion?�Yes ❑No Is ihe side sewer currently UNPROTECTED from se�ver backups(does not have a BWD installed)?❑✓ Yes ❑No Site Inspecfion Checklist: All ifems must 6e checked 'Yes'before inspeclion is considered complete Was side sewer TV inspected from building to sewer main? Q✓ Yes ❑ No Condition: Does side sewer have at least i%slope from Ihe building to sewer main? ❑� Yes ❑No Descnbe: Have all building sewer drain connections to th�side sewer been idenlified and located? Q✓ Yes ❑ No Have all property siorm drainage connecfions lo the side sewer been idenii6ed and located? []Yes ❑No Has property been evaluated(or drainage deficiencies with findings communicated to properfy owne� �]Yes ❑ No Installation Details: What type and brand of BWD was installed al lhis sile(Clean Check BWV,Grinder pump,etc.): Clean Check HWV Where was lhe device inslalled(generai descriplion, aUach map)? See attached as huilt Was there any olher sewer or storm drainage work compleled in conjunclion with Ihe ABWD work?Is so please describe: Installation Checklist: Are all downspouts and site drainag�disconnecled(rom upstream o(the DWD? ❑Yes �✓ No CommeNs: Does BWV posilioning meet minimum slope requiremenl of>1"/e 1 [�Yes ❑No Comments: Can DWV be pulletl out for inspection and mainlenance aiter Ioosening thumb screw? ✓❑Yes ❑ No Is BWV locked iNo Ihe proper position and thumb screw lighlened? U Yes ❑No Circle ihe 4WV cover,irrigalion cover (landscape area)I IraKc load hearing cover(drive surface)1 access hatch f building) Was homeowncr shown Ihe localion oF Ihe inslalled ABWD? ❑✓ Yes ❑Nn Commenis: /� � Pwperiy Owner's Signalure: Ci/�f �;f�� p,31P; li �'l S� inslaller's 5ignalure: Walt "`� '�'X'�/��/i . �,,.,,M,mn;'� Dafe: � ,��-��/� Rev(sion: 2 1 Thursday,October 02,2074