2111 15TH ST 2022-05-31 - Laserfiche WebLink

A BACKWATER PREVENTION DEVICE FINAL 4.7.7. INSTALLATION CHECKLIST Installation Company Name and Contact Info: VkerLb FL i M 13,bute_ E..L c-- Date Backwater Prevention device(BWD)was installed: l—I 0 --1 'S- Date this form was completed: C--l(0 -tS'"' Installation Property Owner Name and Contact Info: Si., Coto iDp Property Address: 211 1 1'S- ' S'C' L V . rr- eA44.-. 90.0 Pre-Installation Inspection Checklist: All items must be checked Yes'in order for a BWD to be considered for installation Is there a basement or level of the house that is at or near assumed sewer main elevation? IX Yes ❑ No Are there fixtures in the house located below the upstream sewer manhole rim elevation?[1Yes ❑ No Is the side sewer currently UNPROTECTED from sewer backups(does not have a BWD installed)? t.Yes ❑ No Site Inspection Checklist: All items must be checked Yes'before inspection is considered complete Was side sewer TV inspected from building to sewer main? JYes ❑ No Condition: OLD Coo/Ott-re Cok) Does side sewer have at least 1%slope from the building to sewer main? Describe: /V/A- Have all building sewer drain connections to the side sewer been identified and located? Yes El No ` Have all property storm drainage connections to the side sewer been identified and located? fYes ❑ No Has property been evaluated for drainage deficiencies with findings communicated to property owner? VI Yes ❑ No Installation Details: What type and brand of BWD was installed at this site(Clean Che , : ,T 7, - . ::- 140 etc.): 2.it-tii Pt0 on._ Drbo") Where was the device installed (general description, attach map . Rac,c2- Pe-4 st Slowx ��'�+F 8 VA u' Was there any other sewer or storm drainage work completed in conjunction with the BWD work? Is so please describe: Installation Checklist: Are all downspouts and site drainage disconnected from upstream of the BWD? ❑Yes ❑ No Comments: PAL Does BWD positioning meets minimum slope requirement of>1%? ❑Yes ❑ No Comments: A1/4- Can BWD be pulled out for inspection and maintenance after loosening thumb screw? ❑Yes ❑ No IV,' Is BWD locked into the proper position and thumb screw tightened? ❑Yes ❑ No i/lg..- Circle the BWD cover: irrigation cover(landscape area)/traffic load bearing cover(drive surface)/acces hatch (building) Was property owner shown the location of the installed BWD? ❑Yes E No Comments: ' '7' Property Owner's Signature: Date: Installer's Signature: _ . --Z— _- Date: 1,--/0 ES- -Revision: 2 1 Tuesday,September 16,2014