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i <br /> i <br /> � <br /> �ACKWAT�R PREVENTION QEVICE FINAL '; <br /> INSTALLATION CHECKLIST ' <br /> � <br /> I <br /> , <br /> �" ct�-�-�! �'i- vtZ 3 � <br /> InstaUa6on Company Name and Canlact into: ��» U e � <br /> Date Backwater Preven8on device(BWD)vras installed: �r3—! Dale this fortn was compiets�: .3-3•-1� j <br /> Installation Property Owne�Name and Confad Into: �;��� �`-��m�'� I <br /> Property Address: �LI�2 La�I�:�� f}U� '%Ve1�� — � <br /> Pre-Installation Inspection Checldist• i <br /> fVl ftems must 6e chedced'Yes'in otder for a BWD lo be considered for installa6on �.,� � <br /> Is there a basement or level of the twuse that is at or near assumed sewer main elevation7�res ❑No i <br /> Are there foctures In the house localed below the upstream sewer manhofe rim elevation7� ❑No <br /> Is the side sewer curtently UNPROTECTEU(rom sewer backups(does n�t havo a BWD fnstailed)?[�fe�s �No � <br /> Site I�spection Checklisl: � <br /> I <br /> All items must be chedced'Yes'before inspedion is cansidered complete � <br /> Was side sev�er N inspeded from buiWing to sewer main? 0� ❑No CondiUon:_�/�.�i ; <br /> Does sido sewer have at least 1%slope From ihe 6uilding to sewer main? �X� ❑No Desaibe: ; <br /> Have all building sev�r drain connections to ihe ske sewer been identified and Iocated7 �s ❑Nc � <br /> Have all propetty storm drainege connectio�s i�tlie side sewer been identified and loca�ed? [L]'�' ❑N� ; <br /> Has property been evaluated for drainage deficencles v+Ah findings oommuniqled lo p�operty owne�? [}'Fes ❑No ` <br /> I <br /> Instellatinn Details: /� � <br /> VYhat type and brand of BWD was in�ielled at lhis sNe(Ciean Chedc BVJV,Grinder pump,etc.): `���-- �%�.� <br /> Whe�e was the dev'ice installed(general d��scriptlon,atladi map)7 _� �-(�'� i <br /> I <br /> Was there any other seweror storm drainage work completed in conJunction with the BWD worKt Is so please describe:_, � <br /> -- /� cre -- � <br /> Ins4alletion Checklist: i <br /> Are all downspouts and site drainege disamneded irom upstraam of Ihe BWD7 �s ❑No Commen�� i <br /> Does BWO positioning mee�minimum slope r^qui�emenl of>t%? �s ❑No Comments: � <br /> Can BWD be pulled out for inspeclion and maintenance after loosaning ihumb saev�R � ❑No <br /> i <br /> Is BWD lociced into tlie proper pasition and � b saew Ughtened7 �-res ❑Nu ' <br /> Circ.le ihe BVI�D wver.irtigation co r Qandscape e tratfic{oad bearing cover{drive surfaoe)/ao�ess hetdi(huilding) ! <br /> Was property ovmar shown the location of the installed BWD1 Ly�res �No Commenis: � <br /> ProparlyUmersSigna .�.� �, .� Date: 3/�'�� � i <br /> . ' � � � Date: ���� ' <br /> Installer's Signature: �h--� ; <br /> Revision:2 1 Friday,Septemher 12,2014 <br />