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Nov.13.2014 12:06 PM PAGE. 1/ 6 <br /> Amerlce�Sep11C 6 Sewer 425-252-5874 v2 <br /> i <br /> � BACKWATER R NTION DEVICE FINAL <br /> /^�,,, INSTA I N CHECKLIST <br /> . <br /> � <br /> ; r� e i"d� 'F�`8i <br /> Ineiallalion Company tJome and Contacl Infa: <br /> Daro 8ackwater Prevendon devlt�(9WD)�res in�tai : � ' Date thls fortn was complehd: �t�l� <br /> Installaiion Properiy OwnerName and Contaet InFo: � � <br /> � <br /> Prop�ty AdOras: <br /> PrednahYation Innprction Cheeklitt: <br /> AllBems must be cbecked��es�M adenbra BWD 6e iderod/orinsteUafion <br /> Is lAere e besement or leve�c�the lwwe Ihat is at or umed sewer mem s'a�f�ion7�Yes ❑No <br /> qre there IlKtures In the house bcated below Ihe ups m r maMole rim elevetlon?�Yes ❑No <br /> Is the sido sewer curtently UNPROTECTEO from se r (does not have a BWD installed)?�VAs ❑No <br /> Slte InspecGon CMeklist: <br /> M�7ems muat be chec!reC'Yes'before inspec(ion Is ns' mmp�ele <br /> Was sde sewer TV inspecled hom buiWing to aewer ein9 �Yes ❑No Condition, <br /> Dces side sewer have at ieaat 1%�lope from the�uil 'ng ewer main? �Yes ❑No Desaibe: <br /> HNVe ell Ouildirg sewer droin�onneclions lo lhe aldo ewe en ideMiAed end loceted7 �Yes ❑No <br /> Hava ell property stam d�a�age connecUons to Ihe r baen Identified and located? �Ye9 ❑Na <br /> Has property bcen evaluaWd for drainage d@fidend wih dings communlcated ta proparty owneR �Yes ❑No <br /> Inenlf�tlon Detalls: <br /> Whaf type and branC of BWD was Inst�lled at Ihia si (Ck CAeck BWV,Gr�der pump,elc•):�or'�^r` 6 L�l� <br /> INhere was the deviae in8teiled(yene�desaiptlon, ttacA ap)7 '��' ''����L�S �t�'�' <br /> Was there any othar eewe�or storm drelnaga work e im m�juncHon wilh tha BWD wo�k7 Is so please describe:_ <br /> Inahlladon Cheeklist: <br /> Are ell tlownspouts and site drsinage disconneched Ir m u ream of the BWD? �Yes ❑No Comments: <br /> Ooas BWD�wsitioninp meete minimum slope requtre ent >1;6? (�1 Yee ❑No Comments: <br /> Can BW6 be pulled out for itlspecilon and maintena e a bosening thumD screWl �Yes ❑No <br /> i3 BWO locked inlo the propet PosMa�and thumb s tlp ? �Yes ❑No <br /> Circle Ihe 8WD cover(!rt9ydon�(�ndscape a )/lr c betl bearing cover(ddve surtece)1 aceess hatch(bWldingl <br /> Was property owner shovm the loralio �h i II �Yes ❑No Camments: <br /> �roperty Owners Sipnalure: ��--=��3 � <br /> Inatallers Signature: <br /> ' Oate: Il�lall�_ <br /> 0.evision:2 ' FAday, SeptemDer 12,207� � <br /> . i —• — <br />