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� BACKWATER PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> f�%*�`;'�ii�� <br /> Installatlon Company Name and i.ontact Inf�:A} P�i �� Y1 �,T�`i-SinF Sr c.t`.(`r�l�h..ry>;��'ci a�'fi� <br /> D�te Badcrvater Prevention device(BWD}was instatled:�_Date thls fortn was compieted: 1 �/�//4 <br /> Installation Property Owner Name and Conlact 1Mo: �� ��°. 'l�w..e./ZSC�� �a5-?�!o- RlD( <br /> PropertyAddress: LOL� �f7 ! �i.l�.(1P�{" Q���7� <br /> r <br /> PrednsFallation Inspection Checkiist: <br /> AO ilems must 6e checked'Yes'fn order f��a BWD fo 6e consldered for inslailafion <br /> Is there a basement or Ievei of ihe house that is at or near assumed sewer main elevationl�Yes ❑No <br /> Are there flxtures in ihe house located below the upstream sewer manhole rim eleva6on7�Yes ❑No <br /> Is the side sewer curtently UNPROTECTED from sewer backups(does not have a BWD inst�!led)7�Yes ❑No <br /> Site Inspecdon Checklist: <br /> All items must be chedced'Yes'6e%re inspec6on is considered complete <br /> Was side sewer N inspeded irom building to sewer main? �Yes ❑No Condition: ��f?� <br /> Does side sewer have at least 1°h slopa from lhe building to sewer main7 �Yes ❑No Describe: <br /> Have all building sewer drain connections to the side sewer besn identified and located? �Yes ❑No <br /> Have a11 property stortn drainage connedions to the side sewer been identified and located? �Yes ❑No <br /> Has property been evaluated for drainage deficiencies wilh fin;iings wmmunicated to property owne�t �Yes ❑No <br /> Installation Details: <br /> What type and brand of BWD was installed at this sRe(Clean Check BWV, Grinder pump,etc.): I�P�J'- � <br /> Where was the device installed(general description,attach map)7 SP P !]li�Ct!'.�wc� aS 1�it .: I-E- <br /> � <br /> Was there any other sewer or storm drainage work completed in wnjunction with the BWD work7 is so please describe:_ <br /> Nc�►� — - <br /> Inetallatlon Checklist: <br /> Are all downspouts and site drainage disconnected from upstream of the BWD7 �1'es ❑No Commenis: <br /> Does BWD positioning meets minimum slope requirement o`>1%T �Yes ❑No Comments: <br /> Can BWD be pulled out for inspection and maintenance after loosening thumb screw? [�Yes ❑No <br /> Is BWD locked into lhe proper pasition and thumb screw dghtened? �Yes ❑No <br /> Circle the BWD co r.irtigatian caver I ndscape area)/traffic load bearing cover(drive surface)I aocess hatch(building) <br /> Was propetty ovmershown fhe loca'on of the in�talled BWD? �Yes ❑No Comments: <br /> P`roperty.OwneYs Signahi�e: . '� Date: 1�- �a-�Y <br /> Installers Signaiure: —� Date: 1 a- l a � 1�}, <br /> Revision:2 1 Friday,September 12,2014 <br />