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BACKWATER PREVENTION DEVICE FINAL <br />INSTALLATION CHECKLIST <br />Installation Company Name and Contact Inio: _ <br />Dale Backwater Pi <br />Installalion Propen <br />Praperty Address: <br />Pre•Installation Inspection Cheeklist: <br />All items musf be checked 'Yes' in order for a 8WD to be considered ior instaNation <br />Is there a basement or Ievei ot the house that is at or near assumed se�ver main elevation? ��s ❑ No <br />Are there fixtures in the house located below the upstream sewer manhole rim elevation? �s ❑ No <br />Is the side sewer currenlly UNPROTECTED from sev+er backups (does nol have a BWD installe�;� es ❑ No <br />Site Inspection Checklist: <br />All items must be checked 'Yes' 6e%re inspection is considered complete <br />Was side sewer TV inspected from building to sevier main? �'� ❑ No Condi�ion: L�^C.r�� � A�� <br />Does side sewer have at least 1°o slope (rom the building to se�ver main7 es ❑ No Describe: b#-R-s l,.al-� y <br />Have all building sewer drain connections to the side sewer been idenlified and located7 �S ❑ No <br />Have all property storm drainage conneclions lo Ihe side sewer been identified and located7 [�'i'�s ❑ No <br />Has property been evalualed tor drainage deficiencies wilh findings communicated to properiy owner? Q'i`es ❑ No <br />Installation Detaiis: /l /%���L <br />INhat lype and brand ot BWD was inslalled at Ihis s�te (Clean Check BWV, Grinder pump, eic.): /`.e�_ — <br />Where was the device installed (general <br />Was there any other serier or storm drainage v�ork <br />attach map)? <br />in conjunclion wilh lhe BWD work7 Is so please <br />Installation Checklist: <br />Are ail downspouts and sile drainage disconnected from upstream of the BWD? es ❑ No Comments: <br />Doas BWD posilioning meets minimum slope requiremenl of >1%? es ❑ No Cammenis: <br />Can BVJD be pulled out lor inspection and maintenanee aRer loosening Ihumb screw? �X�s ❑ No <br />Is BWD locked into the proper position and Ihumb screw tightened? Iy'«s (J No <br />Circle the DWD cover. irrigation cov landscape area ra(fic load bearing cover (tlrive suriace) I access halch (building) <br />Was properly o�vner sho�vn Ihe location of the installed BWD7 �'� ❑ No Comments: <br />Properly C <br />Instailer's <br />Revision: 2 <br />� <br />Date: 3��� <br />oate: � �v�/ S` — <br />Fr�day, September 12, 2014 <br />