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BACKWATER h'rtEVENTION DEVICE FINAL <br />INSTALLATION CHECKLIST <br />Installation Company Name and Conlact Info: A+ Sewer Technoloc ies LLC. (8A8-7_13-76561 <br />Date backwaler device (BWD) was inslalled: Dale this fortn was completed: <br />Installation Properly Owner Name and Contact Inio: <br />PropeRy Address: <br />Pre•Installatian Inspection Checklist: ' � <br />All items must be checked 'Yes' in order lor a 8WD lo be considered for inslalla�ion ,;,{ <br />Is there a basement or level of the house thal is at or near assumed sewer main elevaGon7, �� /1 Yes ❑ No <br />Are there fixtures in Ihe house localed belo�v lhe upslream sewer manhole rim elevalion? � Yes ❑ No <br />Is the side sewer currenUy UNPROTECTED from se�ver backups (does not have a BN�D installed)7 �Yes ❑ No <br />Site Inspection Checklfst: <br />All rfems must be checked 'Yes' be%re inspection is considered complete <br />Was side sewer TV inspecled from building lo sewer main? [�Yes ❑ N�o, �C ndilion: <br />Dces side sewer have at leasl 1% slope from the building to sewer main? '�'es ❑ No De�cribe: <br />Have all building sewer drain conneciions to the side se�ver been idenlified and localed7 QQ �Yes ❑ No <br />Have all property slorm drainage connections to the side sewer been identified and localed? �' Yes ❑ I�o <br />Has property been evaluated tor drainage de(iciencies �vith findings communicated to property owner9 �Yes ❑ No <br />Installation Details: <br />What type and brand of BWD was instalied at this site (Clean Check BWV, Grinder pump, eic.�: Clean Check BWV <br />Where was the device inslalled (general description, allach map)? See altached as bui�, <br />lNas ihere any other sewer or slorm drainage �vork completed in conjunction with the ABWD work? Is so please descrihe: <br />installation Checkiist; �� <br />Are all dovrnspouts and site drainage disconnecled (rom upslream o,_f ,I.t{1�BWD? �es ❑ No Commenis: <br />Does BWV posilioning meef minimum slope requirement o(>1%? ►/J Yes ❑ No C�om enls: <br />Can BWV be pulled out for inspection and maintenance atter loosening Ihumb screw? � Yes ❑ No <br />Is BWV loeked into lhe proper posilion and thumb scre w tightened4 �] Yes ❑ No <br />Circle the BINV cover: irrigation cover (landscape area) ! Iraftic lo tl bearing cover (drive sudace) / access hafch (building) <br />Was homeowner shown lhe loc ion oF the installed AB D? �Yes ❑ No Comments: <br />� <br />Properly O�vner's Signalure: i� � C�/��_, Dale: ��` �'" �.� <br />� Wait �T.�:,Y.,, s � ��_� c�- <br />InstallersSignalure. ��<" Date: —'' <br />Revision: 2 1 Thursday, October02, 2014 <br />