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BACKWaTER PREVENTION DEVICE FINAL . � <br /> INSTALLATION CHECKLIST <br /> Installallon Company Name and Contact Info: /�A �UI'YI I�It',GI , L� L����— ��� � O IZ� <br /> Oate Backv�ater P�evontion device(BWD)was installed: g yi I S Dale ihis fortn was completed: � 5 <br /> Installalion Property Owner Name and Contact into:�Vi n E�v�e M hvQ[a� � � � <br /> PropertyAddress: �%�I�. r-v��dru,� /'cV•2�, �,vr���r�f � w� ��2o i <br /> Pre�lnetellaHon Inepeefion Checkllet <br /> Afl items musf be checked'Yes'in order for a BWD to 6e consldered for instaflation <br /> Is Ihere a basement or level of Ihe house that is at or neer assumed sewer maln elevation7[�Yes ❑No <br /> Are lhere fixtures In the house located below the upstream sewer manhole rim etevation7[,�'S'es ❑No <br /> Is Ihe side sewer curtenlly UNPROTECTED irom sewer backups(dces not have a 8WD Installed)7[[f Yes ❑No <br /> Slte Inepecllon CheeNliel: <br /> All items must be checked'Yes'belore lnspecflon!s cunsidered complefe <br /> Was side sewer N inspected from building to sewer main7 [�}�s ❑No CondiOan:�Cx��- <br /> Does side sewer have al least 1°h slope from Ihe building to sewer main7 ��f'es ❑No Describe: <br /> Heve all bullding sewer draln connectlons to the slde sewer been idenlified and located? es ❑No <br /> Have ail oroperty stortn drainage connections to the side sewer been Identified and localed� ��s ❑No <br /> Has property been evaluated(or drainage deficioncles with findings wmmunicated lo property ovme�l �'Yes ❑No <br /> Inetellstion Detaile: <br /> Whet type and brand o(BWD was instailed at this site(Clean Check BWV,Grinder pump,etc.): cuG�.�+�L` • <br /> Where was lhe device(nstalled(general descripl(on,atlach map)? _�Q ��i.,;L c <br /> �4 �,_r L7 � ��J��2�C� <br /> Was Ihere any ofher sewer or storm drainage work compteted in conjunction wilh Ihe BWD work?Is so please descdbe:_ <br /> Instelletion Checkliet: <br /> Are all downspouls and sile dralnage disconne�led from upslream oi the BWD7 es ❑No Commenis: Y�" <br /> Does BWD positioning meets minimum slope requfremenl of>1%7 !es ❑No Commenis: 1 y� <br /> Can BWD be puiled out for Inspection and malntenance a(ler loosening fhumb scre� (�'�es ❑No <br /> (s BWD locked into the proper posillon and lhumb screw tighfened7 �s ❑No <br /> Circle the BWD cover:Irtigatlon co landscape are /haHic load bearing cover(drive surface)I access hatch(bullding) <br /> Was property owner shown Ihe location ol� he inslalled BWD7 es ❑No Comments: <br /> Property Owners 5ig � Date: g�-?'� 15 <br /> Installers Signature: Date: �"�� �� <br /> Revlsion:2 1 Friday,September]1, 2014 <br />