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i <br /> i <br /> SaCKWATER PREVENTION DEVICE FINAL ; <br /> INSTALE.ATION CHECKLIST i <br /> I <br /> , <br /> , , <br /> !���G �#C_iYj�. <br /> � � <br /> P Y ��/'.i Y� —�i.�ii1-'��_^`-��ir�f'�P_Cil".r �L I,�t.'�!'%:�.:h.i'��1 � <br /> Installallon Com an N3me and Conlact info:Qi'YIP_� r—� <br /> Date Backwater Prevention device(8WD)was fnstalled:��a�te ihis form was compleled:.�.f.�� � <br /> Insfallalion Prooerty Owner Name and Contact In(o: .�1Y't°U�i�de. (�r��i"i'fi����"��'4' � <br /> ProperlyAddress: a Il 1 �jg �Y' A-s-�P�!��'�—� �R� � j <br /> Pre•Instellalion Inspection Checkl(st: <br /> I <br /> All items must be checked'Yes'in order/or a BWD fo 6e cnnsidered lor installafion I <br /> Is there a basement or level of the house that is at or near assumed sewer main elevalion?�Yes ❑No ( <br /> Aie there fixtures in the house located below ihe upstream sewer manhole rim elevation7[a[Yes ❑No i <br /> Is the side sewer currently UNPROTECTED from sewer backups (does not have a BWD instailed)?�Yes ❑No � <br /> Site Inspectlon Checklist: <br /> All items must 6e checked'Ves'6efore inspecfion is ronsidered complete f` <br /> Was side sewer TV inspected irom building to sewer main7 (�[Yes ❑ Nu Condilion:�� I <br /> Does side sewer have at least 1%slope irom Ihe buiiding to sewer ma(n7 �Q.Yes ❑No Describe: ; <br /> Have all building sewer drain cnnnections to the side sewer been idenfified and localed9 �Yes ❑No I <br /> Have all property storm drainage connections lo ihe side sewer heen Mentified and located7 [�Yes ❑No i <br /> Has property been evaluated for drainage deficiencies wlth findi�igs communicated io propedy owner? (�'Yes ❑No i <br /> Installatlon Details: � <br /> What type and brand of 6WD was installed at ihis sile(Clean Check BWV, Grinder pump,etc.): �P C� ��fl PSlt�p � <br /> Where was Ihe device installed (generai description,atlach map)? '`�P P !�i�C2C�1L��s.��..L� I <br /> I <br /> I <br /> Was there any other sewer or storm drainage work compieted in cronjunction with the Bb11D work7 Is so please describe:_ i <br /> ��(� � <br /> Installation Checklist: � <br /> Are all downspouts and site drainage disconnected from upstream of the BWD7 �Yes ❑ No Comments: ; <br /> Does BWD positioning meets minimum slope requirement oi>1%? [�Yes ❑ No Comments: i <br /> Can BWD be pulled out for Inspectlon and maintenance after loosening Ihumb screw7 �1'es ❑ No � <br /> Is BW�locked into the proper position and 1 umb screw tightened? �Yes ❑No ' <br /> Circte the BWD cover: rrigation er land area)/tra�ic load bearing cover(drive surtace)/access hatch(building) <br /> I <br /> Was propeRy owner shown lh loca n of i all d BWD7 �Yes ❑No Comments: I <br /> Date: � <br /> Property Owners Signefure._ � <br /> Installer's Signature: Date: � ; <br /> � <br /> Revislon:2 1 Frlday,September 12,2014 � <br /> i <br />