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BACKWATER PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> Insta!latfon Company Name and Conlact Inio:�Dn��U P t � k S <br /> Date Backwaler Prevention device(BWD)was insfelled:(� -3� I r Date this form was compieted: (o- • !� <br /> InstallaUon Property Owmer Name and Confact Info: LJ �c.f� I� �!� <br /> FropsrtyAddress: �3l A-Iv�✓5�� R L u � <br /> Pre-Installatlon InspecUon Checklist <br /> AIf items must 6e checked'Yes'in order tor a B WD to 6e conside�ed/or insfaUa6'on <br /> Is there a basemenl or lavel of the house that Is at or near assumed sewer main elevationl��Yes ❑No <br /> Are there tixtures In lhe house located below tho up�tream sewer manhole rim elevation7�Yes ❑No <br /> Is the side sewer currenlly UNPROTECI ED from se�ver backups(does not have a BWD Inslalle�?�Yes ❑ No <br /> Slte Inspection Checklist: <br /> All items musf 6e checked'Ves'before inspection Is conside�ed complete <br /> Was side sewer N fnspected irom building to sewer mafn? Yes ❑ No CcndiNon: <br /> Doas side sewer have at least 1°�slope(rom the building to s wer main7 �j Yes ❑ No Descri6e: <br /> Have all bullding sewer dreln connections to the side sewer been Identified and Iocaled7 �]Yes ❑No <br /> Have all property stortn drainage connections to the side sev�er been iden6fled and located7 �Yes ❑No <br /> Has propedy been evatualed for drainage deficiencies vrith flndings wmmunicated to propeity owne�t �Yes ❑No <br /> Installation Detaiis: „-- <br /> What type and brand of BWD was installed al this site( lean Check 8 rinder pump,etc.): <br /> VJhere v+as lhe device fnslalled(general description,altach map)? _ ��•� k �•-.•�Q �o .� .�t����� �r�pS <br /> � .,� � •� � r . - <br /> Was lhere any ofher sevrer or storm drainage work compleled in conjunction wilh the BWD�vork7 Is so please describe:,_, <br /> I� � �> <br /> installation Checkllst: <br /> Are a!I dovmspouts and sile drainage disconnecled from upstream of tho BWD1 [�Yes ❑ No Comments: <br /> �oes BWD positionfng meets minfmum slope requirement oi>t%7 [�Yes ❑No Comments: <br /> Can BWD be pulled out for inspectlon and mainlenance afler loosoning ihumb ar.rew7 �Yes ❑No <br /> Is BWD locked into lhe p;o�o�itionandih 6ghtened7 �Yes ❑No <br /> Circlo the BWD cover.V�ngation cover(landscape ar��!trlfa I�load bearing a�ver(ddve sudace)1 eccess halch(building) <br /> Was property owner sho�ie tion of t :taNed�BWD? �Yes ❑No Comments: <br /> Property Owners S'^nature:_� Date: <br /> InstallersSignatura:�i—""� - Date: l� �' �S <br /> Revlsion: 2 �_ �-� 1 Friday,Septembcr 12,2014 <br />