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BACKWATER PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST , <br /> /[��� �+�'���� <br /> InsteltaVon Cornpany Name and Contact Info:���'�<<t I'1 �'�'t"•`��r�P���1`-Cr �.�(-.�•• �Q�-��1a <br /> Date Backwater Preventlon devke(BVJD)was installed: t I Date this fam was canpieted: ��la ��4 i <br /> InstellaUon Property OwnerName a�id Contact Info: l�yn�e_ Gi�so - 4a6 -aS� �K�-]— i <br /> ProperlyrAddress: ���_i7 � --�k�f�P elC) I <br /> Pn-Md�Non M�peclion Ch�ckliet; i <br /> All items musf 6e dieckad'Yr,s'!n orderlor a BWD fo be cons(derec�lor InslaflaBon <br /> Is there a besemenl or I� �el of the house that is af a near assumed sewer main elevatfon?I�Yes ❑No ( <br /> Are there 6xtu►es in the touse located below the upsiream sewer mani+de rim elevation7�Yes ❑No <br /> Is the side sewer curtenG�+UNPROTECTED from sewer backups(does not have a BWD installed)7�Yes ❑No � <br /> SIEe Anpectlon CMcklbt: � <br /> All ifems musf be checked'Ves'be/ore insoection is considered complefe ( <br /> Was side sewer N inspected irom building to sewer main7 �Yes ❑No Condilion: �� , <br /> Does side sewer have at best 1%sbpe from IAe b�IdMg to sewer main? �Yes ❑No Desaibe: i <br /> Have all bui�ding sewer drain oonneMiona to the side sewer been identlfied end bceted7 �Yes ❑No ` <br /> Heve all piopeAy storm drainage conriectlons to the sfde sewer been Identified and IacetedT (�Yes �No � <br /> Has property been evaluated fa drainage defiaendes with findhgs wmmunicated lo propedy owner7 �'Yes ❑No � <br /> InstMNdon DMaIN: r� <br /> Wi;.at type ard brand of BWD was inslalled at this slle(Cben Check BWV,Grinde�pump,etc.): MGeC�Q�' ��c�� � <br /> Where was the devke instatled(general description,8tt8Ch 1118P�7 SP e � ���d � Px.c.I-f <br /> Was there any oU�er sewer a stam drainage wak completed in con�undion with the BWD work7 Is so please desaibe:_ <br /> Novt� � <br /> MttNlNbn CMckllq: i <br /> Ara all downspouts and site dra(nage discannected from upstream o(the BWD? �Yes ❑No l:ommeMs: � <br /> Does BWD positionfrg meets miNmum sbpe requirement of>1767 �Yes ❑No Comments: � <br /> Can BWD be pulled out fw Inspedion and maintenance afleer loosen(ng thumb saewT �Yes ❑No � <br /> Is AWD locked into the r ition and Ihumb screw tightened? �Yes ❑No � <br /> Grde the BWD .irrig ' . (landscape area)I traflic bad hearinp cover(drive wrface)I access hatch(bullding) � <br /> Was properly owner shown the bcation of the installed BWD7 �Yes ❑No Commenls: � <br /> I <br /> F►oPedY Ownets Signeture: Date: — I <br /> IneWlers Signaturo: �j� ,C� Date: ' I <br /> R�v i s i o n:2 / 1 Frid�y,Se ptember 12,2 014 � <br /> I <br /> � <br />