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BACKWATER PREVENTIOlV DEi/ICE F�NAL <br /> INSTALLATION CHE�KLIST <br /> Inslallation Company��me and Contact lnio: ��,I�o l�l�c b i nc. — <br /> Date Baekwater Prevention device(BWD)vras installed: (n • I - �S Date this fortn was completed: (�-3- �� <br /> Installation Property Owner Name and Contacl Info:,�c ��u CR p �+�v���c9 <br /> Properry Address: 131 LI Co�y a �u R <br /> Pre•Installation InspectionChecklist: <br /> All items must 6e checked'Yes'in order for a BWD fo 6e considered torinstallation ���,,,/// <br /> Is there a basement or level o(the house that is al or near assumed sewer main elevation�Yes ❑No <br /> Are there fi�tures in the house located below the upsiream se�ver manhole rim elevation? Yes ❑No <br /> Is the side sewer currently 11�PROTECTE�from se���er backups(does not have a BWD installed)7�Yes ❑No <br /> Site Inspection Checklist; <br /> All items must 6e checked'Yes'before inspection is considered complete <br /> Was side sewer N inspected from building to setver main? �Yes ❑No Condition: <br /> Does side sewer have at least 1%slope from the building lo sewer main7 [�]Yes ❑No Describe: <br /> Heve all building sewer drain connecfions to the side se�a�er been Identified and localed? (t]Yes ❑ No <br /> Have ail property storm drainage connections to the side sewer been iden'hfied and localed7 [�Yes ❑ No <br /> Has properly been avaluated for drainage deficiencies v�ilh findings crommunicated to properfy owner7 �Yes ❑ No <br /> Installation Details: <br /> What type and 6rand of BWD was insfalled af this site( lean Check B rinder pump,etc.): <br /> Whe�e was the device installed(general description,atlach map)7 �c,�� �-�-i w �� �C �i� <br /> -- —r S-�arir S' <br /> i Was there any other sewer or slorm drainage work cQmpleted in conJunction wilh the BWD work?Is so piease describe:_ <br /> , � p _ <br /> Instnllation Checklist: <br /> Are all downspouts and site drainage dlsconnected from upstream of the BWD7 (�Yes ❑No Comments: <br /> D�es BWD positioning meets minimum slope requirement ot>1%7 �Yes ❑No Comments:_ <br /> Can BWD be pulled out for Inspeetion and maintenance after loosening thumb scre�v7 �Yes ❑No <br /> Is 8WD locked into the pro esiNc+�rand�thambserea htened7 �Yes ❑No <br /> Circle the BWD cover rrigation cover lan cape-a�ea)�lir c load bearing cover(driye surface)1 access hatch(building) <br /> Was properiy owner shown the localion of the installed B1ND7 [�Yes ❑No Comments: <br /> Property Owner's 5ignature:_ Date: <br /> Installers Signature: Date:� s � �S <br /> Revision: 2 1 Frlday,September 12,2014 <br />