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BACKWATER PREVENTION DEVICE FINAL <br />INSTALLATION CHEGKLIST <br />�nst�llation Company Name and Conta�t InFo:�i�//o /�/c,.r��3 r� � �'SS% i.k� <br />Date Becktvater Prevention device (BWD) was inslalled: '�_ Date this fortn ivas compteted, 6 �s' <br />InstatlaGon Property Owner Name and Contact Info� M rc/�//� ff,�? rTJrv <br />Property Address: S�IZ-r GG/ �� <br />Pre-Installation Inspettion Checklist: <br />AU items rr�;:sf be checked 'Yes'in orde� for a BWD to be considered fonnstaflafion <br />is there a 6asement or level of tha house that is ai ar near assumed sewer main elevadon� Yes ❑ Na <br />Are thete fixtures in lhe house �ocaled 6eImN ihe upstream setiver manhoie rim elevation? Yes ❑ No <br />'� the s�de sex�er turrently UNPROTECTED fram sewer 6a�kups (does not have a BWD installe�j?[l Yes ❑ No <br />5de Inspection Checklist: <br />Ali items musf 6e checked'Yes' be/ore iospection is considered cromplete <br />Was side sevret N inspected trom bulding to sewer main7 p Yes ❑ No Condition: <br />Does side sewer have al least 1�fi slope ham the building fo sewer main? (� Yes ❑ No bescri6e: __ <br />Have all buflding se�rer drain conneclions la Ihe side sewer been Identified and lotated7 � Yes ❑ No <br />Have all property storm drainaga wnnedions to Ihe side sewer been identified and located? �] Yes ❑ No <br />Has property been evaluated for drainage deficienn : s with findings communicated to propeAy ovrnefT �] Yes ❑ No <br />Insfallation Detalis: <br />Whal type and brand of BWD H•as installed at ihis ��.an Check 8, Grinder pump, etc.): <br />Where was Ute device inslalled (generai descdplion, a ach map)? c'o:.,�/C? �p�'/' �-. FF <br />�e�'n•f .yf �i:�-�J� rr� .�c>yO�n <br />Was lhere any other sewer nr starm drainage work tompleted in conJuntlion �sith the BWD work? Is so please descdbe: , <br />Installaiion Checkiist: <br />Are all downspouls end sile drainage disconnecled Irom upstream of tho BW�P � Yes ❑ No Cammenis: <br />Does BWD posltioning meets minimum 51ape requiremenl af >1%? [�os ❑ No Commenls: <br />Can BVW be pulled out for inspectlon and maintenance after loosening Ihumb scrow? �/] Yes ❑ No <br />Is BVJD locked into the proper position and thumb szrew tigMened? �T] Yes ❑ No <br />Clrcle Ihe BWD cover.JrtigaTton tov�cNendsC`ape area ic load bearing cover (drive sutface) ! access hatch (building) <br />Was property owner <br />Properry Owner's <br />InsWllers <br />No Commenls: <br />Date: ����f� <br />Dale: ^7%f�f..S <br />Revlsion: 2 1 Friday, September 12, 2014 <br />