919 WALL ST 2022-05-17 - Laserfiche WebLink

��►��a►�r�� sv�ion� ��vac� Fon�A� s�S�}`!i_LATI�N �E��CKL9ST Installation Company Name and Conia�t Info: _MU P� �i�,,�,h;,�.� �j',Z 5` 76U if 360 Date Bac!cv�ater Prevention device (BWD) was installetl: Ff-.2 I- I S� Dale this iorm was wmpleted: �:� d-�r� insiallation Property Owner Name and Contact In(o: K��.v �)�c �l�ro,^ Property Addrnss: c1 /� •.�c i� t� Pre•Installation lnspection Checklist; All items must be checiced'Yes' in order (or a BWD to 6e corsldered forinsteflafion Is there a basemsnt or level oi the house fhat is et or near assumed sewer main elevation? (�S'Yes ❑ �o Are lhere flztures In ihe house locafetl below the upsfream sewor manhole rim elevation7 � Yes ❑ No Is the side se�ver curcently UNPROTECTED from sewer backups (does not have a BWD insialled)7 � Yes ❑ No Sfto Inspec6on Checklist: All items must be checked 'Ves' Geiae Inspection Is considered complete VVas sitla sevaer Tu inspeded from building to sev�er main7 �Yes ❑ IVo Condition: ��-- L� Does side sevrer have ai least 1% slope irom ihe building fo setver main7 �Yes ❑ ho Describe: Have ail bullding sewar drain connoctions to the side sower been identlfied and looated? � Yes ❑ No Have all property storm drainage connections to lhe sitle sevrer been identlfied and lo�ated? (,�Yes ❑ No {,as property ;oen evaluaied for drainago deficiencies wifh findings communicated to preperty owne�l �Yes ❑ No InstallaBon Detalis: Whot type and brand of (iWD was installed at lhis site (Clean Check f3WV, Grinder pump, etc.): �� u•. �r'- Where was Ihe device Inslnlled (yeneral descdption, atiach map)? '�n h<< s•� �. �.-, �f U„ � cr c� I-k Was ihere any other s2wer or storm drainage wodc completed in conjunclion with tho BWD work7 Is so please describe; _ -- 2/�. InstallaEion Checitilst: � Are all dovanspoufs and site drainage disconnected irom upstteam of the OVJD? �5] Yes ❑ No Camments� boes BVVD positioning meets minimum slope requiremenl of >1°l0? �Yes ❑ No C„mments: Can BWD be puiled out tor Inspeclion antl mainfenance after loosening ihumh screw?��' Is RWD lodced into the proper pnsition antl thumb screw tightened7�.�}-Yes'�o Circie Ihr. 6JUD cover, i' � ver (lantlscape area) I treffic load bearing cover (drive sudace} ! access hatch (building) Was p�operty ��rner shown the locallon oi the i�,slalled BWD7 [ts]�Yes ❑ No Comments °ropE.ty Owner's Signature: Date: Installer's Signature: _ � � � Dale, �S' ? � — is Revislon: 2 1 �onday, Septemher 15, 2014