2406 VIRGINIA AVE 2022-05-16 - Laserfiche WebLink

�� ay r: .� h�Ac��4� �� 9�6��'6�i� ��l�6�� 9�i� B��Ra��"��8� ��6��@�0�8��' In.;tailalionCompanyNameandContactinfo: MUe/� PI�,r,h��i� ��'a� Dato Back�vater Prevenlion det�ice (Bl4�D) was inst�lled: � Date lhis form vdas wmpleted: InsfallaGon Property O��ner t�ame and Contact Info; jlc.v�r �Y �✓UU �- �/7_ � 3 3� � a�o Nroperlykddress: �y�i� ��'rc��cn�z_ Pre-Installation Inspection Checklisf: �lfl items must be checked'1'es' in orrier for a BiND fo 6e considered for inslallation Is there a ba,ement or I�vel of the house that is at or near assumed setirer main elevation? � Yes ❑ No Are Ihere fixtures in the house located beiow the upstream sewer manhole rim elevationl0 Yes ❑ No Is the side sa+ti�er curcentl, UNPROTECTED from sev;er 6ac4ups (does not have a BIND instalied)? � Yes ❑ No Site Inspeciion Cheaklist: All rtems must he cheeked `Yes' beforo inspe�tion is consldered complete Was side sev.�er TV inspec�ed from builtling to sower maln7 � Yes ❑ No Condition: C ar�rc �Y Id��u-� Gcc/t Does side sewer have at least 790 slope from the building to sewer main? I�Yes ❑ No Describe; _ I;ave all building se�ver drain conneclions to the sido so�vor been ideNified an� located? ❑ Yes ❑ IJo Have all proper`iy storm drainage connections to the side sevaer been identified antl localed7 ❑ Yes ❑ No Has property been evaluaied for drainage deficien�ies wilh tindings communicated to property owner? U Yes ❑ Ido 6isU:llation Deiails: VJhal type and �rand of BWD was installed at this site (Clean Cher,k BWV, Grinder pump, elc.): VJhere �vas the device installed (general doscription, atiach map)? Was lhere any otiior setver or sio�m drainage vJork cornpieled m conjunctinn v+ith the Bl4�D t�ioric? Is so piease describe: _ Installation Checldis[: Are all do:vnepouis and siie drainage disconnected trom upstream of the BUJD? ❑ Yes ❑ No CommeNs: Doe�, BWD nositinr�ing meets minfmum slope requirement of >1°l�? ❑ Yes ❑ No Commenls: Can 3WD be oulled oul for inspecUon antl mainienance after loosening thum6 screvi? ❑ Yes ❑ �o Is B�VD Ioci<ed into the proper position and thumb screti�i tightened9 ❑ Yes ❑ Nc Cirde the BWD cover. irrigaUon cover (landscape area) ! lraific load beariny cover (drive surface)1 access hatch (building) Was property owner shoem ihe lo�alion oi the installed BWD7 ❑ Yes ❑ No Commeids: Froperly Owner's Signat�are: D2te: _. Insfaller s Signature: "�,�J %��-- Dale: S— 2 U�/� Re��islon: 2 1 Monday, Seutember 15, 2014