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BACKWATER PREVENTfON DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> InstallationCompanyNameandContacllnfo�'���i'���-C'a.V�Si�.1CT�e,��•�s '`�i�������� <br /> Date Backwaler Prevent�m device(BWD)was inslalled:a Z9 /5� Datr.Ihis funii was r.ompleted:�7 S <br /> Instahation Properly Owner Name and Conlact In(o: �c�L �-f'"� �NS f��' �(�- z�� � ��� <br /> Property Address: �5� (rW l l �✓� - --- <br /> Pre-Installation Inspection Checklist: <br /> All ifems mus(be checked'Yes'in order(or a BWD fo be considered Ior inslallafion �,� <br /> Is there a basement or level of ihe house ihat is at or near asswned sewer main elevalion?[J Yes �] No <br /> Are there fixtures in the house located below lhe upstream sewer manhole rim elevation?�_I res []No <br /> Is the side sewer currently UNPROTECTED (rom sewer backups(does not have a E3WD inslalled)?�'es ❑No <br /> Site Inspection Checklist: <br /> All items must be cfiecked'Yes'belore inspection is considered complete <br /> Was side sewer TV inspecteJ from building lo sewer main? QYes ❑No Condilion: <br /> Does side sewer have al least 1%slope from lhe buiiding to sewer main? lJ res ❑ No Describe: <br /> Have all buildiny sewer drain connections to the side sewer been idenlified and locate�i'7 �'Yes ❑No <br /> Have all properry slorm drainage connections to Ihe side sewer been identified and localed? �es ❑No <br /> Has property been evaluated for drainage deficiencies wilh findings communicated to properly owner? ��Yrs ❑ No <br /> Installation Delails: �`�a� C�aG /� <br /> What type and brand of BWD was installed at Ihis sile(Clean Check BWV,Grinder pump,elc.) <br /> Where was Ihe device installed(general description,allach map)? �A"01?` s�� �'S�r� ��� �`��4N'1 <br /> Was there any other sewer or storm drainaye wor oo��i�1 in conjunction wilh Ihe 13WD work7 Is so pleasr.describe:_ <br /> Installation Checklist: <br /> Are all downspouts and sile drainage disconnected from upstieam of Ihc BW�? ��es �.� No Comments: ____ <br /> Does [31ND posilioning meels minimum slope requiremenl oi >t"/o'? [�'�es ❑No Commenls:__ <br /> Can�WD bepulled oitl(or inspeclion and mainlenance aflei loosc:ning Ihumb sr.rew? �vf'�es �� � No <br /> Is BWD lor.ked inlo Ihr,proper position and thumb screw lightened'? (�'Yes ❑No <br /> Cirr.le the BWD cover. irrigalion cover(landsr.ape area)I traflic load bearing r.over(drive surlacr,)I��cce s f�alch(buildin ) <br /> Was propeiy owner shown Ihe lor,ation ol ihe inst• e WD7 ��es ❑No Commenls:_.____ — <br /> i <br /> � Da�e: f�(..�/Z� _/`.� <br /> ?roperty Owner's$igna� � :_ _ — � � <br /> Inslaller's Signalurc � _ � �— Dale' 'r�.�_.���___—___ <br /> Revi;iun�. 7. 1 Monday, tio��lcnibcr I:,, 2U1� <br />