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f <br /> � <br /> BACIC�NATER PREVENTION DEVICE FINAL i <br /> INSTALLATION CHECKLIST � <br /> i <br /> I <br /> � <br /> Installation Company Name and Contact In(o: �'��i� /ti�"�'�� ± <br /> 1 <br /> D2te Backwater Prevention device(81h'D)v+as inslalled:�Date this form�vas comp!eted: l�i��-� I <br /> Installation Property Owner Name and Contact Info: rer��P 13��-f%u ei� — i <br /> Property Address; IZZSt G�G•�n ��� I <br /> f <br /> Pre•Installation Inspection Checkiist: i <br /> All items must 6e checked`Yes'in order for a 8WD to be considered tor installation : <br /> Is there a hasement or level of the house that is at or near assumed sewer main elevation�Yes ❑No � <br /> P,re th2re fixiures in the house located belo�v the upsfream se�ver manhole rim elevation? Yes ❑No ; <br /> Is the side sewer currently UNPROTECTED from sewer backups (does not have a BWD installed)9�Yes ❑No <br /> i <br /> l <br /> Site Inspection Checklist: � <br /> All items must be checked'Yes'before inspection is considered compfete '; <br /> Was side sewer N inspected from building lo se�ver main? �es ❑No Condition: � <br /> Does side seti�er have at least 1°�slopa from lhe buiiding to serHer mainl [�Yes ❑ No Describe: ' <br /> i <br /> Have ail building sewer drain connections to the side sewer been identified and located? �Yes ❑No � <br /> Have all property stortn drainage connecBons to the side sewer been Idenlified and located? �Yes ❑ No ? <br /> Has property been evaluated for drainage deficiencles��+ilh findings communicaled to property o�vner7 [�Yes ❑ No � <br /> Instailation Details: 4 <br /> 1Nhat type and brand of BWD v�as installed at ihis site n ieck B , Grinder pump, elc.): <br /> VJhere was lha device inslalled(general descriplion,atta�h map)? r��»��� r'�� i <br /> Was there any othor se�ver or slorm drainage work completed in conjunation w.ith the BWD wor:c?Is so please descrioe:_ i <br /> A/l _ <br /> lnstallation Checklist: <br /> Are all downspouts and sile drainage dlsconne�ted from upstream of ihe BWD7�Yes ❑ No Comments: S <br /> Does BWD positioning meets minimum slope requirement of>1?'07�Yes ❑ No Comments: � <br /> Can BWD be pulled out for inspection and maintenance after loosening thumb screw? �Yes ❑No � <br /> Is BWD locked int�o the mper•{�es'�' a�u�-�a ned7�Yes ❑No ` <br /> Circle lhe BWD uc� eL_IIIi,qati�e� a ic load bearing cover(drive surface)I access hatch(building) � <br /> Was property owner shown lhe localion of the installed 84VD? [�es ❑No Comments: i <br /> Property O�vner's Signatu � Date: �//9�✓��— i <br /> _ I <br /> Instailers Signatu_,, Date: �l/9/i� i <br /> Fevision: 2 1 Friday,September 12,2014 ; <br /> i <br />