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BACKWATER PREVENTION DEVICE FINAL <br /> E,• INSTALLATION CHECKLIST <br /> , i <br /> Inslallation Company Name and Contact Info � �+(.� �L .�C�oC `�.+.�C_• <br /> Dale Backwater Pre��ent�on device (BWD)was installed: o�-o7S -1 S Date Ihis form was completed .9-��'0-/,5� <br /> Irstallation Property Ovrner Name and Contaet In(o �z. � ., J"c°�I.��S r�n� _ <br /> Propr.rly Address aa aU Ches�n�T S�e e�- L Jar�t� I,�'-� 9�,�0/ <br /> Pre•Installalion Inspection Checklist: <br /> All dems musf be checked'Yes'in order lor a BV✓D to be considered lor insfallalion <br /> Is iherr. a basement or level of the house that�s al or near assumed sewer main elevation?�1 Yes j_] No <br /> Are�here (ixlures in ihe house locatetl below lhe upsircam sewer manhole rim elevation?�Yes ❑ �o <br /> Is the side sewer currertly UNPROTECTED from sewer backups (does not have a BWD insialled)?�Yes ❑ No <br /> Site Inspection Checklist: <br /> All dems musf be checked 'Yes'be%re mspection is considered complete <br /> l�Jas side se�ver N inspected from bui!ding to sewer main? `�1Ces ❑No Condilion: ___ <br /> Does side sewer have al least 19� slope irom the building to sewer main7 �Yes ❑ No Describe: <br /> Have all build�ng see��er d�ain connecl�ons ro Ihe side sewer been iderb(ied and lo�ated7 �Yes ❑ Nc <br /> Have all property slorm dra�nage cornections to Ihe side sewer been idrntilied and tocated? �Yes ❑ No <br /> Has p�operty been evaluated for drainage deliciencies wilh (indings communicaled to property owner��Yes ❑No <br /> Installation Details: <br /> N'hat type and brand oi BW�was insta�led al this sde(Clean Check BNN,Grinder pump,etc.): `I'� C I cr,,,�C{tf•c,k„QI�V <br /> Where was Ihe device installed(generel desr,ription, altach man)7 <br /> VJas lheie 2ny other sev.�er or sinrm drainage work comp'eted m conjun;tion with ihe BN'D�.vork? Is so please descnbe:__ <br /> -�0-- - _- - <br /> Installation Checklist: (((___��� <br /> Me af do�vnspouls and sile drainage tlisconnected lrom upsirr.am of the BWD�?.{t�[I Yes ❑No Comments <br /> Dnns DWD positioning meets minimum slopc requiremenl oi>1%� '�Yes LJ No Comments <br /> Can BWU be pulled out for mspr.r.Uon and mamtenance after loosening thumb scre�v? [7�Yes ( �No <br /> Is B�VD locked �nto the propr,r position and�humh screw 6ghtened� �es ❑ No <br /> Ci�cle ihe BWD cover irrigation cover Qandsr.ape area)11raHic load beanng cover(tlrive surface) /access hatch(building) <br /> Was pruperty owncr sho�vn ihe location of ihe inslalled BWD7 �Yes ❑ No Commenls <br /> Property Owner's Signature:_��� �i.�i.h.aa,v Date; .�- 2--,Zo/ S <br /> Installer'sSignalur��[�.. . '� �'S� / _ _ _ __ Dale: �aS-3o�S� <br /> i � <br /> Revision: 2 1 Friday, September 12, 2014 <br />