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BACKWATER PREVENTION DEVICE FIN�4L <br />INSTALLATION CHECKLIST <br />Installation Company Name and Contact inio: I�oi/�r /'/cr,n �1ng 3.rs �" �5�7 <br />Date Backwater PrevenGon device (BWD) was installed:� /F�/�S' Date this fortn was completed: 3%IG//S <br />Installation Property Owner Name and Contact Info: %r�/(�V ���7Lk�rs�'� <br />PropertyAddress: �/�/ Gci%/31/ <br />Prrinstallation Inspeotion Checklist: <br />AIf items must 6e checked 'Yes' in order for a BWD (o be considered for insfallafion <br />Is there a basement or Ievei of Ihe house that is at or near assumed sewer main elevation? � Yes ❑ No <br />Are there fi�Aures in ihe house located below the upstream ser�er manhole rim elevation? [�] Yes ❑ No <br />Is the side sewer �urtently UNPROTECTED from sewer backups (does not have a BWD installed)?�j Yes ❑ No <br />Site Inspectior Checkl(st <br />All rfems must be checked 'Yes' 6efore inspeclion is considered complete <br />Was side sewer N inspected from building to sewer main? �j Yes ❑ No Condition: <br />Does side sewerhave at least 1%slope from the building to sewer main7 [� Yes ❑ No Describe: <br />Have aIi building sewer drain connections lo the side sewer been idenBfied and localed? �Yes ❑ No <br />Have all property storm drainage ccnnections to the side sewer been idenlified and localed? � Yes ❑ No <br />Has propeRy 6een evalualed fordrainage deficiencies wilh findings communipted to property otivne�T � Yes ❑ No <br />Installalion Oetalls: <br />Whal type and brand ot BWD was inslalled ai this site (Clean Check BNN, Grinder pump, elc.): ST4n�,ri� !�r/G <br />1Nhere was the device instailed (general desuiplion, attach map)7 �n r.�!n � i,.� Gc� r.�s,�. ero .� <br />V'!as there any other sewer or slorm drainage work completed in conjunction �vilh the BWD woric? Is so please describe: _ <br />lnstallafion Checklist: <br />Are all downspouls and sile drainaga disconnected from upslream of the BWO? �] Yes ❑ No Commenls: <br />Does BWD posiGoning meets minimum slope requiremenl of >1°/a7 ,� Yes ❑ No Commenls: <br />Can BWD be puiled out for inspection and maintenance afler loosening ihumb screw? [� Yes ❑ No <br />Is BWD locked into the proper position and thumb screw <br />Circle the BWD cover: irtigaUon cover (landscape are ��1 <br />Was property owner shown Ihe localion of the installed E <br />Properry Ovmer's <br />Installcr's <br />load <br />1 access haich (buiiding) <br />❑ No Comments: <br />Date; 3�� -G,/�.� <br />Date: -���/v��.f� <br />Revisian: 2 1 Friday, September 12, 2014 <br />