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BACKWATER PREVENTION DEVICE FINAL <br />INSTALLATION CHECKLIST <br />Installation Company Name and 0ontact Info: <br />Date Backwater Pf <br />Installation Proper? <br />Property Address: <br />Pre -Installation Inspection Checklist: <br />AU items must be checked 'Yes' in order for a BWD to be considered for installation <br />Is there abasement or level of the house that is at or near assumed sewer main elevation? es ❑ No <br />Are there fixtures in the house located below the upstream sewer manhole rim elevation? es ❑ No <br />Is the side sewer currently UNPROTECTED from sewer tackups (does not have a BWD installed)? D>re's ❑ No LL <br />Site Inspection Checklist: <br />All items must be checked 'Yes' before inspection is considered complete V ) <br />Was side sewer TV inspected from building to sewer main? O-YEs ❑ No Condition: o ✓ &Ive- L <br />Does side sewer have at least 1% slope from the building to sewer main? � ❑ No Describe: <br />Have all building sewer drain connections to the side sewer been identified and located? Q Yes ❑ No <br />Have all property storm drainage connections to the side sewer been identified and located? [Yes ❑ No <br />Has pros irty been evaluated for drainage deficiencies with findings communicated to property owner? ❑1 .Yes'❑ No <br />Installation Details: <br />What type and brand of BWD was installed at this site (Clean Check BWV, Iprinder pump, etc,): <br />Where was the device installed (general description, attach map)? <br />Was there any other sewer or storm drainage work completed in conjunction with the BWD work? Is so please describe: _ <br />n64 <br />Installation Checklist: <br />Are all downspouts and site drainage disconnected from upstream of the BWD? [g-Yfts ❑ No Comments <br />Does BWD positioning meets minimum slope requirement of >t%? [r}-Yes ❑ No Comments: <br />Can BWD be pulled out for inspection and maintenance after loosening thumb screw? [ryes ❑ No <br />Is BWD locked into the proper position andribio+bvzw tightened? ❑-Yes ❑ No <br />Cirde the BWD cover imgation C4�—landsca area)�l traffic load bearing cover (drive surface) I access hatch (building) <br />Was property owner shown the location of the installed BWD? ayes ❑ No Comments: <br />Property Owner's Signature: — <br />Date `"I 1/66 <br />Instailer's Signature: -- Date C 'ZS <br />Revision: 2 1 rridav, September 12, 2014 <br />