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. .. . . .. !�0. 1329 P. 7 ` <br /> � <br /> BACKWATER PREi/ENTION DEVICE FINAL � <br /> ! <br /> INSTALLATION CHECKLIST � <br /> i <br /> Installa0on Campany Name and ContaG Info:��� . L �G i <br /> �ate Backwater Prevention dev�ce(BWD)�res inst�IleO: 2�2{j `15 Date�his form w&s compieted:2 7.� � 5 ` <br /> ,installatlo.a Property Ovmer A`ame and Conla;�InPo: ' 1 <br /> ProPerry Address: I S Q � �Q,��' ZS 3 S 2 �7 0 I <br /> --. �4 Co I b �e W `l8z v l i <br /> Pre•Instalfadon Inspection Checkiist: j <br /> All,tems must be checked'Yes'In orde�lor a BWp tn De conside�ed lor inslallation I <br /> Is Ihere a bagement or level of Ihe house that is al or neer assumed sewer main eleuation?�y� �ho I <br /> Are there fixtures in the house tocated 6ebw Ihe upsfream sewer manhole rim elevation?,�Ye9 �� I <br /> Is the side sewer currenlly UNPRDTECTED fmm sewer 6aCkupS(does rot have a 6WD inslalied)T(�Yes ❑No � <br /> Site Inspection Checklisl: i <br /> All flems musf be chedred'yes'belore inspection is aw�sidered campfetv � <br /> Was slde sewer N Inspected from build�ng fi s,wer maln? �Yes ❑No Condi�on: � <br /> Dces stde sewer have at least 196 slope Yom the building to se�,ver nain7 (�,Yes ❑No Doscribe� � <br /> Nave all 6ullding sewer drain ConneclJons to Ihe slde sewar been Identlfied and locatedq ' <br /> Have elf property slorm drainage wnnections lo the side sewer been WenGfled end Iocated7�YeSyes�No � <br /> Has woperty been evaluated for drai � G'No � <br /> nage deficiencles w;th findings communipted to property ownen [�ye5 �No � <br /> InsUllffiion Deteils: ; <br /> What typo and brend of BWD was inslalled at Ihis site(Clean Check BWV, Ori�der p�mP,etc.): C l ec.�v�c�C c�C. I <br /> i <br /> Where was Ihe dsvice installed{genetal descrip6on,atfach map}? �p•��-r�i� �d v 5� � <br /> � <br /> � <br /> i <br /> Was Ihere any other sewer or storm dralnege work compfeted in conJunctlon with(he 8W0 work7 Is so please descnbe: I <br /> —�P — � <br /> Installetion Checklist: � <br /> Are nll downspauls and sife drainage d�sconnecbd 6om upstroam ol the pWpp ; <br /> Does BWD positioning mcets minimum slopo iequlrement ot�19;7 �Ycs [J No Cammenls�� ; <br /> Cen BWD be pulled o�dlw inspectlon and mair,tenence aRer foosenln�g f umb❑w? �mments:�`_ � <br /> Is BWD locked inin Ihe prop�,y pos�on a humb saew II htenedl �'Y� �No � <br /> Cirde the BWD eaver. Inlgation cov r landscape area 1 tratfic load be�g cave�r(dnve sudace)/actess hetrh(buitding) ' <br /> Was proporty ow�er shown Ihe tocatlon o(Ihe i sfailed BWD? �Yes []No Comments; ' <br /> ----.-� i <br /> � <br /> Property Ormer's Signature: � <br /> Instauer's Signoturc: DaOe; 7i Z(j � j <br /> oate:` '_ 2�(']��y� ( <br /> Revlslon:2 ��-- <br /> 1 Friday,September 72, 2014 I <br /> -- i <br />