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f <br /> � <br /> �ACKWATER PREVENTION DEVICE FINAL ; <br /> INSTALLATION CHECKLIST ; <br /> i <br /> Installation Company Name and Contact In�O: {-,� ('�`1 u �\u�u�\�� i <br /> Date Baclnvater Prevention device(BWO)was ins�ailed:L a-� �I � Date ihis form was completed: 5 -�� �� I <br /> Installation Property Owner�ame and Confact info: l-os�� /✓��-� (u5 k� ' <br /> � <br /> ; <br /> PropertyAddress; `��YbS Col ,� a��Q <br /> Pre•Installation Inspection Checkiist: ' <br /> A!!itsms must be checked'1'es'in order(or a BIND to be considered/orinstalfation � <br /> Is there a basemenl or level oi the house that is at or near assumed sewer main elevation7[�Yes ❑No i <br /> Are ther�5riures in the house localed below the upstream setiver manho!e rim elevation?�Yes ❑No a <br /> Is the side se���er currently U�PROTECTED from sei^er backups(does not have a BVVD instelled)7�Yes ❑No � <br /> Site Inspectlon ChecklisL• � <br /> Ali ifems must 6e checked'Yes'before inspection is considered complete I <br /> 1Nas side sewer N fnspected from building to sen�er mainl ¢]Yes ❑No Condition: i <br /> Qces side sewer have at least 1°lo slope from the building to se�ver main? �Yes ❑No Describe: <br /> Have all building sev�er drain connecfions to ths side sewer bezn identified and located? [�]Yes ❑No , <br /> Have all properfy stortn drainage connections to the side sevrer been identified and locaied? �Yes ❑No ', <br /> Has properiy been evaluated(or drainage deficiencies wiin findings communicated to property owner7 [�Yes ❑No � <br /> r � <br /> , <br /> Installation Details: � � <br /> 1��hat type and brand oi BWD was installed at ihis si e Clean Check BNN, G[i der pump,elc.): ; <br /> INhere vras lhe device installed(general description,attach map)7 l�rtic_I���I � ��'" S'��- �':( � <br /> i n a�r,� „� P I��tir i• n�,�.t,. , <br /> r � ' <br /> Was lhere any oiher se�ver or slorm drainage vrork completed in conjunction with the BN'D work?Is so please descnbe:_ , <br /> tS >(is �v��� ;I 0 ,( .� ,,.i�l- <br /> Installation Checklist: � <br /> Are all downspouts and site drainage disconne�ted irom upstream of the 81ND7 �Yes ❑No Comments: i <br /> Does BWD positloning meets minfmum slope requirement of>1%? �Yes ❑�o Comments:_� E <br /> Can BWD be pulled out for inspection and maintenance a(ler loosening thumb scre�v7 [�Yos ❑No i <br /> Is BIND locked into lhe propo�ositiotranc}thum rew tightened? �Yes ❑No � <br /> Circle lhe BWD cover, i�gation cover(landscape area I traffic load bearing cover(drive surface)1 eccess hatch(building) i, <br /> Was propedy owner sho��n-Uaeaesa4ion�ithe m�d BWD7 [/[/.�Yes ❑No Comments: f <br /> Property O�vner's Signalure: Data: <br /> _ � <br /> Installers Signature; Date: �� � �'- �S � <br /> � <br /> Revision:2 1 friday,September 12,201Q � <br />