4202 COLBY AVE 2016-01-01 MF Import

i ; � BACKWATER PREVENTION DEViCE FINAL INSTALLATION CHECKUST � ,�►��r�c�zn ��p�-�� sc�L7d' L LG Ins,aUetion Comp2ny Name and Contact Info;T��C.0 ;«,(y� •�:�, .��,�� , . z„� �, � : � /��,)` ��D .�i-,,<� Date Back�.vater PrevenGon device (B'ND)was inslalled:��_pate ihis form was compleled:�_ !nstatialion Property O�+�ner��Jame and Contact Info:�S(.�' �k. � ' � Ih ' � r n _--�-_�a � �1..._._�S��i�v -f-(-(Cl� Properiy Address: �;>�Da �?,�f ��1� i ,t11 �' • j^ � )7�j�{�x�'' ��?C i� Pre•Installation Inspection Checklist: All items must be checked 1'es'in order(or a BV✓D to 6e cansidered for rnstal/afion is 'here a basement or level o(the house thai is 2,cr near assumed se�ver main olevaGon%[�j�j'es ❑ No kre,here fixtures in the house located belo�v ihe upstream sewer manhole nm eievation7��Yes ❑ No Is the side setivor curreniiy UNPROTECTED(rcro sewer backups (does nat ha�re a BbVD installed}?��es ❑No 5ite Inspection Checklist: All ifems must be ch,ecked'Yes'6e(ore rnspection is considered complefe Was side sevrer N inspecled from building to see:er main? (�-Yes ❑No Condition:��'.� Does side sew�er have at least 1%slope from lhe building to sevrPr main? �Yes ❑ No Descnbe: Have all buildi�g sewcr drain connections to the side sewor been identified and ioca;ed? �Yes ❑No Have all prooetiy stortn drainaae conneclions to the side sewer been identified and loca!ed? �,�Yes ❑ No Has property been ev,�luated far drainage deficiencies wifh findings communi�aled ;o property owner7 �],Yes ❑ No installation Oetails L�l�hat type and oranc7 ot BWD was inslalled al lhis site(Ciean Check BWV, Grinder pump, etc�:_��—_^� ' Where was the device installed(general description,attar.h map)? _�N f' /;� C`(GF '_ lC'c� �1�<' (/-� 4Vas there any other sewer or storm drainage work comp;e'eo in eonjunclio with the BWD�vork7 Is so please describe: ---�— — -- ----�i1 i'��` — Installation Checklisf: Are all doemspouts and sile drainage disconnected(rom upsiream o!the BWD? �1-Y'es ❑ No Commen�s: Ooes BV1�D posilioning meets minimum slope requirement oi>14o7 �es ❑ No Comments: Can BbVD be pulled out fnr inspection and mainfenance afler Icosening thumb scre�.v? [�.�Yes ❑ No Is D4VD locked into Ihe pro er posilion and thumb screw tighteoed? �"1'es ❑No Circle the BWD cover. i ation cover�dscape area)/traffic load bearinc�cover(drive surface)/access hatch (building) Was property owner shown Ihe locaficn of ihe installed BWD? ��fes ❑ No Commenls: /''� _:_�, , Property Owner's Signafure: /�'�—�-^i""� ��ro�— ' ____ Date: Installers Signature�_ / � �� / � �� Dato: �fl)/ Revision:2. i f'riday,September 12, 701a