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BACKWATER PREVENTION DEVICE FINAL. <br />Ozy <br />"Tr iNSTALLAMN CHECKLIST <br />!nstallation Company Name and Contact Info: Moe^ ),JV, r" b. ,t y Ll � � _ Lu o <br />Date Backwater Prevention device (BWD) was installed: ,fT Date this form was completed: <br />Installation Property Owner Name and Contact Info: S C e�� 14,\ N2 f 2 79- 70 ( -2- <br />Property Address. _ LYUol I 6-rfi L a--c- <br />Pre•installation Inspection Checklist: <br />All items must be checked 'Yes' in order for a BIND to be considered for installation <br />Is there abasement or level of the house that is at or near assumed sewer main elevation? EfYes ❑ No <br />Are there Fixtures in the house located below the upstream sewer manhole rim elevation? ® Yes ❑ No <br />Is the side server currently UNPROTECTED from sewer backups (does not have a BWD installed)? ® Yes ❑ No <br />Site Inspection Checklist: <br />All items must be checked 'Yes' bafore inspection is considered complete <br />Was side sewer TV inspected from building to sever main? N Yes ❑ No Condition: C1 r CA /Uo � e Acr-c <br />Does side server have at least 1% slope from the building to sewer main? (Yes [-]No Describe: <br />Have all building sewer drain connections to the side sewer been identified and located? ® Yes ❑ No <br />Have all property storm drainage conne^lions to the side sewer been identified and located? KJ Yes ❑ No <br />Has property been evaluated for drainage deficiencies with findings communicated to property owner? ZYes ❑ No <br />Installation Details: <br />What type and brand of BWD was installed at this site ( Bwv, Grinder pump, etc.): <br />Where was the device installed (general description, attach map)? (%4� ci L <br />Was there any other sewer or storm drainage work completed in conjunctlon with.te BWD work? Is so please describe: _ <br />Installation Checklist: <br />Are all downspouts and site drainage disconnected from upstream of the BWD? Z5 Yes ❑ No Cnmments: <br />Does BWD positioning meets minimum slope requirement of >1%? N Yes ❑ No Comments: <br />Can MID be pulled out for inspection and maintenance after loosening thumb screw? �B] Yes ❑ No <br />Is BIND locked Into the proper position and thumb screw tightened? 0 Yes ❑ No <br />Circle the BWD cow «i ation cover ndscape area) I traffic load bearing cover (drive surface) I access hatch (building) <br />Was property owner shown the location of the installed BWD? Yes []No Comments: <br />Property Owner's Signature: <br />-�'�-- <br />Installer's Signature: Sz�-, -- <br />Revision: 2 <br />Date: <br />Date: �, 'g,- f 1 L <br />Monday, September 15, 2014 <br />