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BACKWATER PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> Instaliation Company Name and Cocta�;t Inlo:�;��.(' �?�'��,��_ <br /> Dale Backe+a�er Prevention device((3'��vD)was inslalled: I I �� Dafe Ihis form w�s compieted: 3 I� <br /> Installalion Prop�rty Owner Name acd Conlact Info: �1't'X �1C (7(�CI 1"�Z � Nt�1 y(��C..Q <br /> Prope�y Addres�: Z��'�YGl�1��� `_ <br /> Pre•Installation Inspeclion ChecklisL• <br /> All ilems must be checked'Yes'in order lor a Bl-VD fo be considered for insfailation <br /> Is Ih?re a basement or level of lhe house that is at or near assumed sewer mzin ele�,�alion?�j Yes ❑No <br /> Are Iheie fixlures in Ihe house loca'ed 6elo�;�(he upslrzam sewer manhole rim elevalic,n��Yes ❑ No <br /> Is the side sewer currenlly UNPROTECTE�irom setiver backups(does nol have a 6VdD inslal!ed)? �Yes ❑ tJo <br /> Slte Inspection Checklist: <br /> Allifems must te ch?c�ed'Yes'betore ir,sp^ction is considered compfele <br /> INas side searer TV inspect^d(rom building to sevrzr main? �lYes ❑ ho Condiuon: <br /> Dces side se�;re�have at lezst 1°'o slope from the building to sewer main? �Yes ❑ �do Cescribe: <br /> H�ve all building sea.er drain connections to ihe side see�er been identi ied and localed7 fes ❑ No <br /> Nave all property slorm drainage conneotions to fhe side sewer been identified and localed7 � Yes ❑ iJo <br /> Has property be�n e.aluated(or drainage deficiencies v�ith 6ndings cnmmunicaled to property owner? � 1'es ❑No <br /> Installatlon Details: <br /> VJhal type and b�and o(BWD was installed at lhis sile(Clean Check BNN, Grinder pump,etc.�: ((p�.✓i C��G� <br /> 4Nhere�vas the device inslalled(genera�tles�ription, allach map)7 _ '�Ca�,.��U Y'G�l _ <br /> Was there any other sewer or storm drainage t;�ork completed in conjuncl�on��;ith the BlNO e�oik7 Is so ptease describe:_ <br /> �I VGC�F.�- S��J fX' '�r� �X (n �� -1YGl.tn-S V'+1 6Y\ . <br /> Installallon Cliccklist: <br /> Ara all downspouts and sile drainage disconnected from upslream ot Ihe BWD? �1'es ❑No Comments: <br /> Does BWD posilioning meels mfnlmum slope requiremenl of>t°6? r�Yes ❑No Commenis: <br /> Can Blh'�be pu!Ied oul for inspeclion and mainlenance aiter loosening lhumb screw7 'F/�Yes ❑No <br /> Is BWD locked inro Ihe proper position and lhumb screw lighfened? [�Yes ❑ No <br /> Circle the BWD cover. ' riqation cover(iandscap e-�lraffic load�earing cover(drive surface)!access hatch(Gui�ding) <br /> Was property owner shown Ihe I a ion of lhe ins all d BWD7 �Yes ❑ ho Comments: <br /> '� ✓ /�� ' / d �/� <br /> Properiy Ovmers 5ignature: Dale: <br /> InslallersSignalur : � �. Dale: / � /,3��_ <br /> Revision: Z 1 Frfday, September 12, 2014 <br />