1615 OAKES AVE 2016-01-01 MF Import

BACKWATER PREVENTION DEVICE FINAL _ INSTALLATION CHECKLIST Installation Company Name and C�nla�t Info: c�'S PLUMBING 8 SERVIC[LLC 360�691-5159 Date Backwater Prevention tlevice(BWD)was installed: 'OE�- �-��Date ihis iorm was completed:�v' �Z-I`S Installation Property Owner Name and Contact Info: �CJI�`,'� ` �►`=�= Property Adtlress: (01� ��-5 A�`+-�• FUO'�`'44 Pre•Installation Inspection Checklist: All ilems must be ciiecked 'Yes'in order for a B WD fo be consideied for installation Is Ihere a basemenl or level of the house thal is at or near assumed sewer main elevation?�Yes ❑ No Are there fixtu�es in the house lo�aled below lhe upstream sewer manhole rim elevalion? �'Yes ❑No Is the side sewer currently UNPROTECTED from sewer backups (does nol have a BWD installed)? �Yes ❑ No Site Inspection Che�klist: All iterns must be checked 'Yes'before inspeclion is considered complete Was side sewer TV inspecled(rom building to sewer main? [�Yes ❑ No Condition: ��^• S��- �� Does side se�ver have at leasl 1%slope from Ihe building lo sewer main? [/�Yes ❑ No Describe: Have all building sewer drain connectio,is lo the side se�er heen identified and located? [j�Yes ❑ No Have all property slorm drainage conneclions to the side sewer been idenlified and localed? �Yes ❑No Has property been evaluated ior drainage deficiencies vdith findings communicated lo property owner? /�Yes ❑ No InstallationDetails: �,��,,,,t n��\� Whal type and brand of BWD v�as installed at this site(Clean Cneck BWV, Grinder pump,etc.)R� � �.occ,1�� c.,e+F�. S�� e�l-' 4tin�-n Where was lhe device inslalled (general description, altach map). �h� 1� u.w1.� �r��.�-� 1� l c �r �� s Was ihere any olher sewer or storm drainage work completed in conjunclion v�ith ihe BWD v+rnk? Is so please descnbe._ Inslallation Checklist: Are all dovmspouls and sile tlrainage disconnecled Irom upsiream o(lhe B�R�D? �Yes ❑ No Commenis: Does BVt�D positioning meets minimum'�slope requiremenl of>1%? [�Yes [� No Commenls: Can BWD be pulled oul(or inspeclion and maintenance after loosening ihumb screw? �Yes � i No Is BWD locked into the proper position and ihumb screw tightened? �Yes ❑IJo Circie ihe BWD cover:irrigation cover(landscape area)1 Iraf(ic load bearing cover(drive surface)I access hatch(6uilding) Was property owner shown the loca�ion of lhe installed BWD? �Yes ❑No Commenls: Properly Owner's Si ia �8'`�l ��^� _ Dafe: (n - �1 - � 5 Inslaller's Signalure. � Dale. �'� �Z- � � Revision: 7 1 Friclay,September 12, 2014