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�a��� ���.5 � - • - <br /> .��� �'� BACKWA'�ER PREVENTION DEVICE FINAL <br /> � <br /> IN�TALLATION CHECKLIST <br /> , <br /> � . <br /> Installaliop Company Name and Conlacl Inip: 1.:� o P• bi y.2S S j �3$9� <br /> Dats Backwater Prevention device (BWD)v�as installed: �l a � �� Date this form was compleied: �2.�FS- l. <br /> Instailation Property Owner Name and Conl�ct Info: mr.��{ Cl��Q�-S �0(0"�S� -�D/ � <br /> PropertyAddress: 13�(n L.�Jr-,'� Jre� �r. ��-e.�j', (�� J� 5' $026 ) <br /> . Pre-Installation Inspection Checklist: i <br /> All items must be checked'Yes'in order forl a NWD to be considered(or installation <br /> Is there a basemert or level of the house th�3t is at or near assumed sewer main elevation? Yes ❑No <br /> Are inere fixlures in the house located belov�the upstream sewer manhole rim elevation? Yes ❑N/ <br /> Is the side sewer currently UNPROTECTED;from sewer backups(does not have a BWD installed)? [�Yes [_J No <br /> . � <br /> 5ite Inspection Cheak�ist: � <br /> All iterns musl6e checNed 'Yes'be(ore inspRction is considered complefe <br /> Was side sewer N inspected from building�o sewer main? 'es ❑No Condition: _ <br /> Does side sewer have at least 1%slope fror�ihe building to sewer main? Yes ❑ No D cribe: <br /> Have all building sewer drain connections td the side sewer been identified and located? Yes No <br /> Fiave atl proH�rty storm drainag�connectioris to lhe side sewer been identified and located? Yes ❑ No <br /> Has property been evalualed for drainage d�:ficiencies wifh findings communicated to property owner7 [�'�s ❑ No <br /> � <br /> Installation Details; <br /> What type and brand of BWD was installed�t this site(Clean Check BWV,Grinder pump,etc,): '.e�rn � __ <br /> Where was the device installed (yeneral de�cription,attach map)? �^AP A�"�9e.,v9�1_� <br /> Was lhere any other sewer or storm drainag�e work completed in conjunclion wilh the BWD work? Is so please describe:l�� <br /> , Installation Checklist, : <br /> Are all downspouts and site drainage disconnecfed iroin upstream o(the BWD? [�es ❑ No Commenls: <br /> Does BIND positioning meets minimum slop�requiremenl of>7%? �es ❑No Comrtients: <br /> Can BU��D be pulled out for inspection and rriaintenance after loosening ih (b screw? [✓j�Yes ❑h;, � <br /> la BWD locked into lhe proper positlon and hu b screw ti tened? Yes ❑ No <br /> �S`E�L.YTZ CQ,/ � . <br /> Circle the 8WD cover.irrigatlbTl'L•wer(land�cape area)1 tra ic load bearing cover(drive surface)(access halch(buildin�) <br /> Was properiy owner shown the location of tlje installed BWD? Q Yes ❑ No Comments: _ <br /> � <br /> - � �Z�B/Z6 �y <br /> �Property Owner's Signa _ � �_Dafe:� <br /> Installer's Signatur : - � Date: �2 / <br /> !tevision:2 1 Mnnday,Sep[ember 15, 7.014 <br /> . ., . <br />