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� <br />� <br />BACKWATER PREVENTION DEVICE FINAL <br />INSTALLA710N CHECKLIST <br />i islallatinn Company Name and Conlacl Info: <br />Dale Dackwater P <br />Inslall5lion Proper <br />Property Adtlress: <br />Pre�lnstallation In _ � _ ___„ _„_,,, <br />Af! rtems must be checked 'Yes' in order lor a pIND to be considered lor insfallation <br />Is Ihere a basemenl or level of the house thaf is al or rear assumed sewer main elevation?�Pti <br />Are fhere fixlures in Ihe house Incafed below lhe u slr 1 <br />❑ No <br />Is Ihe side sev�er curreNly UNPROTECTED from ewer backups (does nlotrhave aVpfWD i r� I d)? �es <br />Site fnspection Checklist: ❑ �Jo <br />AI! Rems musl Ge r,hecked 'Yes' belorr. inspection is c�nsidored mplele <br />l'das side sewer iV msper.ted from ouildmg lo se�n�er main7 �Yes ❑ No Conditlon. <br />Do�s side sewer have at Ieast 1'/� slope from �he building to sewer main9 �Yes ❑ No D scrioe: <br />Have all building sewer drain conneciions to the side sewer been idenlified s.�d localed? <br />f{ave all property slorm drainage connecfians lo Ihe side sewer been identified and localed? Ye� � No <br />Has property been evalualed br drainage deficieneies wilh findings communicated to property p� �7 ( 7 Yes <br />Installatlon Details: L� Nu <br />'•'d�'ai �YPe and brand of DWD was instailed at ihis site (Clean Cher.k B�1N, Grindor purnp, etc,),���., �. /'/.��.(� <br />VJLr�re was Iha devir.c inslalled (general desr,ri lion, altach ma � •y�s��L� <br />------ P P)� � w v -�_ _-- — —_ <br />- L <br />L'Jas Ihere any ntner sev�er or storm drainage vmrk compleled in conjunclion wilh ihe E�WD work? Is so please desrnhe: �'�,�� <br />Installation Checklist: <br />k�e a�l dovmspouts and sito drainaye tlisconnected from upstream of the WD? _ Yes ❑ No Commenis: <br />f%ces EIWp �si6oning mee�s minimum slope requiremenl ot >1 °/a? (�es ❑ No <br />;':r� !3WD be pulletl oul lor msp^ction and main�r.nance �dler lo�;r.n�ng Ih� h screv�� <br />'; EiVJD locked mto Ihe proper posi�ion and fr,umb screw tu�hfened7 [ Yes ❑ Nn <br />C,�de I�ie BWU cover: irrigation cov��n �e . r.a ��� <br />',;'��s property owner shown (he Ip� n of Ihr. in;tallr.� <br />N��F����ty Owncr's Signalure: <br />Insfaller's 5ignalure: �/v(�,�(,�,,,� <br />kcv�sinn: 2 � <br />Co menis <br />---- <br />[ Yes [J No <br />ng covcr (drive su�tace) / access hafch (6uddiny) <br />f _1 N� Comments: <br />---------- <br />-- �Dafe: l� �J� � <br />q� /-�/----- - <br />— -- — Daln: ,—�! l _� _/ <br />—!_Jr-_-- <br />MondaV. ;eptcrnb�r 15 ��nin .eo <br />