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BACKWATER PREVENTION DEVICE FINAL <br />INSTALLATION CHECKLIST <br />Installation Company Name and Contad Info: /�r'a//ci j'/i� �h'.= <br />Date Baclnvater Prevention device (8WD) was installed:�?�?Z�f�s'� Date lhis farm �vas crompleted: � 13 � <br />Inslalialion Property OwnerName and Contact Info: ��.� /.frv��: r�/r.x n <br />PropertyAddress: ,r�i// G �/l3 y <br />Pre•Installation Inspection Checklist: <br />AII items mus( tre checked Yes' in order for a 8WD fo 6e considered for installa6on <br />Is there a basement or levei oi tte house that is at or near assumed sewer main elevation? Yes ❑ No <br />Are there fixlures in the house located below the upstream sewer manhole rim elevation? es ❑ P;n <br />Is the side sewer currenlly UN?ROTECTED irom se�ver backups (does not have a B�VD installed)? � Yes ❑ No <br />Site Inspection Checklist: <br />All items musf 6e checked'Yes' before inspection is cronsidered complete <br />Was side sewer N inspected from building to sewer main7 Yes ❑ No Conditfon: <br />Does side sewer have at ieast 1°/a slope frem the building to s wer main? �j Yes ❑ No Describe: <br />Have all bullding sewer drain wnnections to the side se�ver been idenlified and located? �j Yes ❑ No <br />Have all property storm dreinage conne�tions to lhe side sewer been idenGfed and located? �i'es ❑ No <br />Has property been evaluated for drainage defitiencies with findings tommunicaled to property owne�l � Yes ❑ No <br />Installation Details. <br />Whal type and 6rand of BVJD was installed et lhis siie � ean"'C�Check�IVV rinder pump, elc.): _ <br />Where vras the device installed (general description, attach map)? �✓,r�t� t; ��. c�+`- J,��s� <br />Was Ihere any other sewer or storm drainage work completed in conjunction �vilh the BYVD work? Is so please describe: _ <br />Instailation Checklist: <br />Are all downspouls and site dra;nage disconnecled Gom upslream of Ihe BWD? �Yes ❑ No Commenls: <br />Does BWD posiGoning meeis minimum slope requirement oi>1%a? �Yes ❑ No Commenis: <br />Can 8WD be pulted out for inspecGon and mainlenance afler loosening Ihumb screw? �/]�Yes ❑ No <br />Is BWD locked inlo lhe proper posifion and Ihumb screw tightened? � Yes ❑ No <br />Circle iha BWD cover: irrig ion <br />Was property owner shoan lhe <br />Pmperty Owners 5ignature• <br />Inslaller's SignalurP. � <br />v <br />Revision: 2 <br />load bearing cover (drive surface) ! atcess hatch �building) <br />� Yes ❑ No Comments: <br />Date: 3/? 3/i r' <br />Date: -���3/i,� <br />Friday, September 12, 2014 <br />