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BACKWATEFt PREVENTION DEVICE FINAL <br /> �. <br /> INSTALLATION.CHECIfLIST <br /> InstallationCompanyNameandContactlnto: �/�a//a ��k.�'�D%�a <br /> �u•l7=lr , �, 1,r- <br /> Date Backwater Prevenlion device(BWD)was Installed:�Date lhis tortn was compieted: �4`�-� I r <br /> Installation Property Owner Name and Contact Inio:,1'f�� F/l�S — <br /> PropertyAddress: �u� A�verfon �?�vn <br /> Pre•Installatlon Inspection Checklist: <br /> All items must be checked'Yes'in order(or a BWD fo 6e considered(a insfallation <br /> Is there a basement or tevel o(lhe house that is at or near assumed sewer main elevation9[�Yes ❑No ' <br /> Are lhere fixtures in the house localed bolow the upstream sewer manhole rim elevafion?(�Yes ❑No <br /> Is the slde sewer currently UNPROTECTED(rom sewer backups(does not have e BWD installed)9[�Yes ❑No <br /> / <br /> Site Insp¢ction Checklfst• � <br /> All ifems musf bo checked'Yes'belore inspection is considered wmplete <br /> Was side sewer N inspected irom building lo sewer main? �Yes ❑ No Conditlon: <br /> Does side sewer have at least 1%slope from lhe building to sewer main7 �Yes ❑No Describe: <br /> Have all building sewer drain connections to tho side sewer been idenlified and located7 �Yes ❑No <br /> Have all property stortn drainage conneclions to the side sewer been identified and located7 [�Yes ❑ No <br /> ' Has property been evalualed for drainage deficiencies with findings communicaled to property owner7 �Yes ❑No <br /> '� <br /> Installetion Details: �.� <br /> What type and 6rand oi BWD was installed at this sit (Clean Check B , rinder pump,etc.): <br /> �_= � . <br /> Where was Ihe device installed(general description,attach map)1 ��Yi� �� r„�t;� EU �•;� ��' � <br /> Tln tie •,D <br /> Was lhere any other sewer or storm drainage woik completed in conjunction wilh the BWD work7 Is so please describe:_ <br /> 1 C l -- <br /> Installalion Checklist: <br /> Are ail downspouts and site drainage disconne�ted irom upslream ot the BWD? [�Yes ❑ No Commenls: <br /> Does BWD positioning meets minimum slope requiremenl oi>1%7 [�Yes ❑No Comments: <br /> Can BWD be pulled out for inspection and maintenance after loosening thumb screw? [�Yes ❑No <br /> Is BWD locked into lhe proper position and lhumh screw tightened? �Yes ❑ No <br /> Circle the BWD cover: irtigalion cover(landscape area)I traffic load bearing cover(drive surface)I access halch(building) <br /> Was property owner shown the location of the inslalled BWD? �Yes ❑No Comments: <br /> ; Propedy Owner's Signah • - - ' � � �/� �' Date: • <br /> � InstallersSignalur . � Date: 3�3/ /S' <br /> � Revislon: 2 ' 1 Friday,Septembcr 12,2014 <br /> 1 <br />