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BACKWATER PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> Installation Company Name and Conlact Info: MuC�` ��in M b�n y y ;�5= �60 - }13(oU____ <br /> �ate Backwater Prevenlion device(B1ND)n�as inslalled I�" f�/- Iy Da;e this form was completed 1 I - �v- I y <br /> Installation Property Owner Name and Conlact Info:_I�ti�c/i l�� k ur'� �� ��a S=.2�S'",�`f5d <br /> Property Address:�� 02 S ����✓ S!, �=�.-���e �-t_+.-��___ <br /> Pre•Installatfon Inspection Checklisl: <br /> All items must he checked 'Yes'in order fo�a BIND fo be considered lor insfallation <br /> Is Ihere a basement or level of Ihe house ihat is al or near assumed sewer main elevalion?[�Yes []No <br /> Are Ihere fxtures in tha house located below the upstream sewer manhoie rim elevation? [�Yes ❑No <br /> Is the side see�er currentiy UIJPROTECTED from sewer backups (does not have a BWD ins!alled)? �Yes [ �No <br /> Site Inspection Checklist: <br /> All items must 6e checked 'Ves'be�ore inspecfion is considered complete <br /> INas side sewer TV inspecled from bwlding to sev�et main? �Yes [� No Condition: nu c�cic s .a� ,11�'J _ <br /> Does sido sewer have at least 1%slope from the builtling to sewer main? [�Yes ❑ No Describe: I <br /> Have all building sewer drain connections to the side sewer been ideniified and localed? �Yes ❑ No li <br /> I lave all property storm drainage connections to Ihe side sewer been identified and located? n Yes ❑ No ' <br /> Has property been evalualed for drainage deficiencies wilh findmgs eommunicated lo property owner7 �X]Yes { � No ' <br /> Installation Details: ' <br /> 1Nhat lype and brand ol BWD was installed al this site(Clean Check BWV, Grinder pump, etc.): e��ks <br /> VJhere was the device mstalled(general desaiplion, atlach map)? ���ic r.e�� IJ L c��ne� , <br /> �4>U_�n-_ wc.�� f�r tl- d�vr� <br /> Was there any olher sewer or storm drainage work cumpleted in conjunction wilh the BWD work? Is so please desr.ribe:_ � <br /> -��'��--- - -- ; <br /> Installation Checklist: I <br /> Are all downspouls and site drainage disconnected irom upstream o(the BWD? �Yes ❑ No Commenls_ _____ _ <br /> Does DWD positioning meets minimum slope requimment of>i%? �Yes ❑No Comments:____ � <br /> Can BWD be pulleA oul for inspection and maintenance after loosening thumb screw? �Yes �._f No <br /> Is BWD locked into the proper posilion and Ihumb screw tighlened? �Yes ❑ No � <br /> Circle the BWD cover: irrigalion cover(landscape area)I traffic load bearing cover(drive suriace)1 access halch(building)^/�A ', <br /> Was property owner shovan Ihe lor,alion o(ihe installed BWD? gYes ❑ No Commenls: <br /> Property Owner's Signature:. Date: i <br /> Inslallers Signalure: �_ �--___ Dele: I I - f`1� ��/ ' <br /> Revision: 2 1 Monday,September 15,2014 <br />