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BACKWATEa PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> i�stallation Comp2ny Name.and Contact Inio: �—^-���� ���`n-� ���"� <br /> Date Back�vater Prevention device(BN�D)was Installed: CO'� '�� _Date this torm tvas complated la—�I`I S. <br /> Installa6on Property Owner Name and Contact Inio: Ma�vi�n J��0.5 p t.,cZ <br /> PropertyAddress: `}.o'Z-� C.o14,� �1�� . � <br /> Pre•Installation inspection Checklist: <br /> ,411 items must be checked'Yes'in order for a BV✓D to bs co��sidered for installaG'on <br /> Is there a basement or level of lhe house that is al or near assumed sev�er main elevalion7�]Yes ❑No <br /> Are there fiaiures in the house located belo�v the upstream sewer manhole rim elevation?�Yes ❑,,c,�o <br /> Is the side se�ver currently U�PROTECTED from sewer backups(doss not have a BWD Installed)1�I Yes ❑No <br /> Site Inspection Checklist; <br /> All items must be checked'Yes'6efore inspection is considered complete � <br /> VJas side se�ver N inspected from building to sewer main? �}Yes ❑ No Condition: <br /> Does side setver have at least 1%slope from the building to sewer main7 �]Yes ❑No Describe: <br /> Have all building sewer drein connecilons to the side sever 6een Identified and located? �]Yes ❑No <br /> Have all properiy storm drainage connections lo the side sewer been identified and Iocated2 �Yes ❑No <br /> Has property been evaluated for drainage deficiencies tvifh findings communicated to properiy owner? �'S'es ❑ No <br /> Installation Details: <br /> What t��pe and brand of BN�D was insfalled at lhis site( ean Che�inder Pump,etc.): <br /> Whete�t�as lhe device inefailed(general description,attach map)7 f��rti�k����-� �u� G 11�� �JV � <br /> Was lhere any other sev�er or slorm drainage work complefed in conjunction with ihe BWD workl Is so please describe:_ <br /> r. ��� <br /> Installatlon Checkiist: ' <br /> Are all dow�nspouls and site drainage dlsconnected from upstream of the BWD7 �Yes ❑No Comments: <br /> Does BWD positioning meels minimum slope requirement of>1%7 �Yes ❑No Comments: <br /> Can BWD be pulled out for inspecfion and mainlenance after loosening lhumb screw7 �LI Yes �No � <br /> Is B11'D locked into the proper position and Ihumb scre�v tightenedT �Yes .ho <br /> Circle the BWD cover.Imgatlon cover(landscape ar�ay! r�affic load beanng eove�(drive surf�cess hatch(building) <br /> Was property owner shotim fhe location of the inslall�ed'BbVD7�i`�'�'es—[1�1 omments <br /> Property Owner's Signature: Dafe: <br /> Installers Signature: � Dale: b'�'�5 <br /> Revision:2 1 Friday,September 12,2014 ' <br />