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Backwater Prevention Device <br />Property Owner Rebate Form <br />Please verify the following items: <br />[1�4 am the owner of the property served by the side sewer where the Backwater <br />Prevention Device was installed. <br />Ukl worked with my contractor to determine the installation location for the Backwater <br />Prevention Device. I understand that the final decision regarding installation location <br />was mine. <br />Q.Tf the Backwater Prevention Device was installed on my property: <br />1 have been shown how to access, inspect, and maintain my device by my <br />contractor <br />• 1 understand the City will not maintain the Backwater Prevention Device. I <br />am exclusively responsible to maintain it and to keep it in good working <br />order. <br />If I sell my property, I will make the buyer aware of the Backwater <br />Prevention Device and the need to maintain it. <br />Choose one of the following: <br />As of now, my property has no downspouts or other onsite drainage that connects to <br />the side sewer upstream of the installed Backwater Prevention Device. <br />or <br />I still have downspouts or other onsile drainage that connects to the side sewer <br />upstream of the installed Backwater Prevention Device. I understand that leaving these <br />connections means that the risk of flooding from downspout or onsile drainage remains. <br />I accept that risk. <br />Signature c Date <br />Page 2 of 2 <br />Revised 0910912014 <br />