1731 WETMORE AVE 2022-05-17 - Laserfiche WebLink

I BACKWATER PREVENTION DEVICE FINAL INSTALLATION CHECKLIST i i'►'�'ri c�zn �;� �� r �� c��, L LG ; installation Company Name and CONact Info�S�C,��((' �{�'��"�+--��5<j�(��.�,�:iL��v'�;,Z ' Date Backwater PreveNion devi�e(BWD)was installed�—�)I'aG'�Date ihis form was completed:_y't"=,"�'""_ � Installation Property O�vner Name and Conlact Info:_l PC'D�P.i�� I�}'�,(�.�"�Yl._T_qa�—.S.�Z,� '-�]G>�9 , Properly Address: l•7�)� �'�-�Ylc 3'Y' t?E' . C' �)�/�G#-� ��'�) � Pre•Installation Inspection Checklist: A!1 rtems must he checked'Yr.s'in order for a BWD to be r.onsidered for installation , Is there a basement or level of the house that is at or near assumed sewer main elevalion?(�Yes ❑No ; Are there fixtures in the house located below lhe upslream see�er manhole rim elevation?�'Yes ❑No , !s fhe side sewer currenlly UNPROTECTED(rom sower backups(does not have a BWD installed)9[�Yes ❑No Site Inspection Checklist: AN items must be checked'Yes'before ir :pecGon is considered complete Was side sewer N inspected from building to sewer main? �1'es ❑No Cundition: �i9J� Does side sewer have at teasi t%slope frorn the builtling to sewer m2in? �Yes ❑ No Describe: Have all building sewer drain connections to the side sewer been identified and located7 �.Yes ❑No Have all property storm drainage connections to Ihe side sewer been identified and locatetl? �Yes ❑No Has property been ovalualed tor drainage deficiencies wilh fndings communi�ated lo properly�wner2 [�Yes ❑No Installation Details: , Whdl type and brand of Bl4�D was installed at this site(Clean Check BWV, Gnnder pump,etc.): - r�=� LVhere�vas the device inslaVed(yenerai description,attach map)? . ' � ' � ,�B_LL�.�� Was lhere any other sewer or storm drainage work cotnpkled in conjunction v�ith ihe BW��vork? Is so please describe:_ r.lcSl-,n Installation Checkiist: Are all do�vnspouls and site drainage tlisconnected from upslream of the BVJD? [gYes ❑No Commenis: Dnes BWD positioning meek minimum slope requiremenl 01>1%? [�]c Yes ❑No Comrnenis:_ _____ � Can 8WD be pulled out for inspeetion and maiNenance after loosening lhumb screw? �Yes ❑No Is BWD locked into the prnper position and Ihumb screw tightened? [�'Yes ❑No Circle Ihe BWD co r:irri alion cov �Qandscape area)1 tra(fic load bearing cover(drive surface)I a�cess hatch (building) ' � INas property owner shown ihe location of the installed BWD? �Yes ❑ No Comments: ; � . r� Property Owner's Signature: �-tC-c t�:.C✓ �l f�� Dafe: �"�'W"/5� Inslaller's Signature: / '-f',Gt� Date: •-� � /,�-- l Revision:2 1 Friday,Seplembcr 12, 2074 ' ;