3010 16TH ST 2022-05-18 - Laserfiche WebLink

� � BACKWATER PREVENTION DEVICE FINAL INSTALLATION CHECKLIST Installalion Company Name and Contacl In(o: , .� �tI' (c- � (v�,a�� - yZ5 �i7S"-4`f[.� Dale Backwater Prevenlion device (8WD) was inslalled: 3/� � S Date this (orm was completed: 3 10 �� Inslall�lion Properly Owner Name and Conlacl In(o: w��i ie.w-. �,.-Y� vd� _ Property Addcess: ,vv-� = i��—'�'� ic \ D 1 �-k� SF �.V u�t 4f �,l ,A �t4.J.a l Pre�lnstallation Inspection Checklist: All items must be checked'Yes'rn order for a BWD to 6e considered (or installation Is lhere a basement or level of ihe house lhat is al or near assumed se��er main elevation? � Yes ❑ No Are there fixtures in the house localed below Ihe upstream sewer manhole rim elevation? � Yes ❑ No Is lhe side sewer currenity UNPROTECTED frum sev�er backups (does not have a BN'D inslalled)? � Yes ❑ No Site Inspection Checklist: All rtems must 6e checked 'Yes' befoie inspeciion is cansidered complete Was side sewer TV inspected (rom o��ilding to sewer main? (�] Yes ❑ No Condilion: Iw . �k � r° �ti� �"•j°`s Does side sewer have at leasl 1% slope (rom the building to se�.ver main? � Yes ❑ ho Describe: Have all building sewer drain cnnnections to the side sewer be�� idenlified and localed? �.Yes ❑ Rb Have atl property storm drainage conneclions to ihe side sewer been itlenlifed and locatetl? (�Yes ❑ No Has properly been evaluated tor drainage deficiencies wilh findings con�municaled to property owneh Q-Yes ❑ No lnstallation Details: What type and brand of BWD v�as inslailed at this site (Clean Check DWV, Grinder pump, elc.): �I e�•� C�'IcL� �� `� Where �vas the device insialled (general descrip�ion, altach map)? LL�'^'"' �� h'd��— a� ��-�� " �1 � Was Ihere any olher sewer or slorm drainage �voric completed in conjunclion �vilh ihe BWD work? Is so please describe: _ In�tallation Checklist: Are all do�vnspouts and site drainage disconnec',ed from upsiream of ihe BWD? � Yes ❑ No Commenfs: Does BWD positioning meets minimum slope requiremenl of >1%? � Yes ❑ No Camments: __ Can BWD be pulled out (or inspecUon and maintenance after loosening Ihumb screw? �j Yes ❑ No Is BN'D locked into lhe proper posilion and Ihumb screw tightened7 (�iJ Yes U No Circle �he BWD cov r. irriyalion cover andscape area)1 Iralfic load bearing cover (di�ve suriace� 1 access halch �building) Was propedy owner shovm iheln har on of Ihe installed BVJD? .� Yes ❑ No Commenis: Properly Ownels Signaiure: �� v^"'�"``� Date 3��'" '� Inslalle�s c��na��rP• —�� `--- Date: �' � �' " � � Revision: 2 1 Friday, Septembcr 12, 2014