3830 WETMORE AVE 2022-05-18 - Laserfiche WebLink

� BACKWATER PREVENTION DEVICE FINAL INSTALLATION CHECKLIST Inslallation Company Name and Contact Info;�dc /�/�.�R,i a �/sSJ 3Sf7— �5�7 Dale Backwzfer Prevenfion device (BVVD) v✓as installed: �� Date lhis form v;as compiefed: /�S /.S� Insfallation Property Owner Name and Contact Info: pa:,ni r Oav;S -�� /�>9� Property Address:,�� w � ��' Pre-Installation Inspection Checklist: � All items must be check.ed 'Yes' in order for a BV✓D lo be consiaered ror instalfation Is thzre a basement or levei ot the house lhat is at or near assumed seerer main clevatien? �Yes ❑ IJo Are there nxtures in ihe house Iocated below the upstraam sev;er manhole rim eteva!ion? �Yes ❑ No Is ihe side sewer currznUy UNPROTECTED irom see,er backups (does not have a 814�D insta!led)? ji]1'�s ❑ No 5ite Inspection Cherklist: Al! iter.�s must be checked 'Yes' before inspec5on is consrdered comp;ete l�1'as side �ewer TV inspected irom building to se�ver main? ((�Yes ❑ No Condition: Does side sev✓er f�ave al least 1°lo slop= irom fhe building to sevder main? �j Yes ❑ No Descnbe: Have ali building se�+�er d�ain connections to the side see,�er been idenfifed and localed? � Yes ❑ �'o Have ali property slorm drainage connections to the side sev�er been idenliFied and localetl? � Yes ❑ No Has property been evaluated for drainaye defi�iencies vrith (indings communicated lo property owner? � Yes ❑ No Installation Details: Wnat type and brand of BIND �vas installed at this �Clean C- c-[31�1 , rmder pump, etc.): _ 1Nhere was the device insfalled (general descriptien, attach map)? _%2n t�t�� _� �^-� ��` '' "'Y 1'Jas there any other seerer or slorm drainage tvork completed in conjunction �vith the DI'1'D v�ork? Is so please describe: _ Installation Checklist: Are all downspouts and sile drainage disconnecied (rom upslream of the dVJD? �Yes ❑ No Commen(s: Does E3WD positioning meets minimum slope requirement of >t°6?� Yes ❑ IJo Comments: Can BN�U be pulled out for ins�ectiou and maintenance after loosening thumb screer? � Yrs ❑ No is BWD locked inlo the proper �osifo a d thumb screw tightened? � Yes ❑ No Circie ihe Ol4'D cover mgalion cover lan r � raffi� load bearing cover (drive surface) / access hatch (building) 14�as property o��oner shown lhe localion of ihe inslalled D? �/ Yes ❑ No Commants: Property Owner's Signalure: , ....�.---- Date: l/ / Z I/,s- Inslaller's 5ignzluw-�� - Date: %/ i L/ �.3� Revision: 2 1 Monda��, September 15, 2014