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BACKWATER PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> Installal�on Company Name and Contact Info /1%(-�io ��i�. ��?� n 4 ��)3�f7— !S�7 _ <br /> Date Backwalcr Pievenlmn device jBlh'D) was installed �<'��/�Da:e lhis lo;m was complete,l ��/ �/5�� <br /> Instailalion Property Ov�ner Name and Contact info , Z enu., ,Tol��, SG2_.___ _________________ <br /> Property Address �. 3�� C �' i�tr _ ___ <br /> Pre•Installation InspecHon Checklist: <br /> All items musf be checked'Yes'm ordm for a BWO to be considered/orinstallalion <br /> Is there a hasement or Icvei of ihe house that is at or near assumed sewer main elevation��Yes [_]No <br /> Are Ihere f xtures in ihe house located beto���the upstream sewer manho!e rim e'evat�on?�Yes � <br /> Is!I,e side sewer currenlly UNPROTECTED from se�,ver backups(Aoes not have a B�:VD mstaued�? i Yes [ ] No <br /> Site Inspectlon ChecklisL <br /> All items musf be checked'Yes'6elore inspecfron is considered corpplefe <br /> / <br /> Was side sewer N i^spected ircT building to sewer ma�n? «j Yes ❑ No C nd�hon <br /> Does side sewer havr. at leasl tt�< slope from the building to sewer mam? Yes U No Describe <br /> Have all building sewer �raln connectrons lo Ihe s�de sewer been idenl�fied and located7 �Yes j]No <br /> Have all property slorm dralnage connec6ons lo lhe side sev;er been �dentified and located� �es �)No <br /> Has property been evaluated�or drainage deGc�encies v:dh findings communicated lo property owner� es []No <br /> Installation Details: `^� <br /> Whal type and brand ot BVJD was installed al lhis site`lea�Check B�VJV, Griptler pump,etc� _ <br /> VJhere v�as Rie dewce installed (general description,attach ma�'T �''�u�,y �� ________ <br /> Was�here any olher sewer or storm drainage work compleled in conjunction wdh Ihe BWD work7 Is so please describr _ <br /> ��� <br /> Insfallat�on Checklist: <br /> Arr. al �.puuls and sife dramagc d sconneded Irom upslream of ihe BWD7 j�Yes ( ]No CommeMs ___ <br /> Dues Ell':D positmning mccls mmimum slope reqwrement o(>1°m? �Ye� �� No Commenls __ _ __ ,_ <br /> Can BWD he puiled nut for inspection and ma,ntenance afler loosening Ihumb screw� (/� Yes � �No <br /> Is BWD locked into ihe proper position and thumb screw bghtened?�j Yes ❑ No� <br /> —�-� <br /> Circie the BWD cove(J-nfigalion cover Qandscape area) I U�Kc load bearmg cover (drive surface)I access hatch(bwiding) <br /> Was property owner�ho�vn the IecaUortvttheinstaUed BWD? /�Yes ❑ No Comments _ <br /> � � <br /> Properfy Owner's SignaNre _ �-,� ! .,r> _ Date .j� �� __ <br /> Installer's Signat� — Dalc ,_/��2 ��_._ <br /> Revision 2 1 Fnday, September 12, 2014 <br />