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BACKWATER PREVENTION DEVICE FINAL <br /> INSTALLATION CkECKLIST <br /> InstallaGon Company Name and Contact Info:,�;�h�u��-���1 a� ,�e�� <br /> Date Backwater Prevenlion device(BWD)was installed: �-g�/a°�y Date this fortn was completed: �- £�-ao/ <br /> Inslallation Property Owner Name and Contacl Info: O� (/-' r e, � � ' $��' `� <br /> PropertyAddress: a� CO .� CtvC- �Ue1Ze. q Sav <br /> Pre-Installation Inspection Checkifst: <br /> AU items musf 6e checked'?'ss'in order for a BWD to 6e considered for installation <br /> Is lhere a basement or level of the house that is at or near assumed sewer mai�elevation7�Yes ❑No <br /> Are there flxtures in the house located below the upstream sewer manhole rim elevalionl�Yes ❑ No <br /> Is the side sewer currently UNPROTECTED from sewer backups(does not have a BWD installed)?�Yes ❑ No <br /> Site Inspection Checklfst: <br /> All items must 6e checked'Yes'6efore inspection is consldered complete <br /> Was side sewer N inspected from building to sewer main7 �]Yes ❑No Condition: <br /> Does side sewer have at least 1%slope from the building to sewer main? �,Yes ❑No Describe: <br /> Have all building sewer drain connections to the side sewer been identified and locatedl �Yes ❑No <br /> Have all prope�y slorm drainage connections to the side sewer been identified and localed? j$J Yes ❑ No <br /> Has property been evaluated for drainage deficiencies with findings communicated to property owner7 Yes ❑ No <br /> Installation Details: R¢� 2 sec,I <br /> What type and brand of BWD was installed at this site(Clean Check BWV,Grin�er pum�",�etc.): r.�Eu.�� G�� <br /> Where was the device installed(general description,attach map)?�nSI �on1 W- C�S'�' Z (Zor� �C <br /> �ex�Cl�"r� ' <br /> Was there any other sewer or stortn drainage work completed in conjundion with the BWD work?Is so please describe:_ <br /> �� <br /> Installation Checklist: <br /> Are all downspouts and site dreinage disconne�ted from upslream of the BWD? �.Yes ❑ No Commenls: <br /> Does BWD positioning meets minimum siope requirement oE>1°/a? �Yes ❑No Cornments: . <br /> Can BWD be pulled out for inspection and maintenance after loosening thumb screv✓t ,�.Yes ❑No <br /> Is BWD focked fnlo the proper position and thu b rew fightened7 �Yes ❑No <br /> Circle the BWD cov� irrigation cove (landscape area) traffic load bearing cover(drive surface)!access hatch (building) <br /> Was property owner shown lhe location of the ins ed BWD? �Yes. �No Comments: <br /> Property Owners Signature: ' - \ � � Dale; <br /> Installers Signature: Ao � �Id�Y/ Dale:I�-A—��I�I <br /> Revision:2 1 Monday,September 15,2014 <br />