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BACKWATER PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST ' <br /> ; <br /> ; <br /> Installation Company Namo and Contact Into: fj/fi//D /��w�/3iny ' <br /> Date Backwater Prevention device(BWD)vras inslaVed: ?o Dale this tortn was compleled:_:L�1.� � <br /> Installafion Properfy Owner Name and Contact Info: /1/�/l A l/��n <br /> Property Addrass: 2.°/v /�l✓�r5oi7 <br /> Pre-Installation Inspectlon Checklist: <br /> All items musf be checksd'Yes'in order for a 8WD to be considered for insfallatlon <br /> Is there a basement or level of the house lhat Is at cr near assumed sewer main elevationl(�Yes ❑No <br /> Aro there fixtures in the house located below Ihe upstream sewer manhoie rim elevation?�Yes ❑No <br /> Is the side sewar curtently UNPROTECTED irom sewer backups(does not have a BWD instalted)?�(Yes ❑No <br /> Site Inapection Checklist: <br /> All 8ems must be chscked'Ves'before lnspsction is considered complefe <br /> Was side sexrer N inspected from building to sewer main? �Yes ❑No Condi6on: <br /> Does slde sewer have at least 1°�stope from the buiiding to sewer mainl �Yes ❑ No Describe: <br /> Have all building sewer d21n connections to the side sewer been identified and Iocated7 �Yes ❑ No <br /> Have all property storm dra!nage conneciions to lhe side sewer been identified and locatsdl �Yes ❑No <br /> Has property been evaluated for drainage deficiencies with findings communicaled to property owner? �Yes ❑No <br /> InstallaUon Details: <br /> What type nnd brand of 8WD was installed et fhis sile(Clean ChecY.BWV, Grinder pump,etc.): .4R 5 Rw'✓ <br /> VJhere was the device installed(general descriplion,atlach map)7 ;n i)us�.rrc'n� <br /> Was there any olhor sower or sform drainage woric completed in conjunc6on v6th the 81VD�vork7 Is so please describe:_ <br /> Nv <br /> Installation Checklist <br /> Are a(I downspouts and site drainago disconnected from upstream of Ihe BWD? �Yes ❑No Comments: <br /> Does BWD positioning meets minimum slope requiremenl ot>1°h7 �Yes ❑No Camments: <br /> Can BWD be pulled out for inspectlon and mainfenance afler loosening lhu!rh screvlt �Yes ❑No <br /> Is BWD locked into lhe proper posilion and ihumb screw tlghlened? �Yes ❑No <br /> Grcle the BWD�v tlrngation cover(landscape ar Ua(fic load beadng cover(drive surface)I access hatch(building) <br /> Was property owner shown the loation of ihe Installed BWD7 �Yes ❑No Comments: <br /> Property Ovmer's Signature��_. Date: � J � <br /> Installefs Signatur Dale: J/w/i.r <br /> Revision:2 � 1 Friday,September 12,2014 � <br />