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� <br />� <br />Backwater Prevention Device <br />Property Owner Rebate Form <br />Please verify the tollowing items: <br />�am the owner o1 ihe property sen�ed hy the side sewer where the Backwater <br />Preven6on Device was installed. <br />(—(}�iworked with rny cunlractor to determine ihe installation location for the Backwater <br />Pre��ention Device. I undersland thal the final decision regarding instailation lucation <br />was mine. <br />"� f the Backwater Prevention Device was installed on my property: <br />• I have been shown how to access, inspect, and maintain iTiy device by my <br />contractor <br />I understand the City will not mair.tain the Backwater Prevention Device. I <br />am exclusively responsible to maintain il and to keep it in good working <br />order. <br />If I sell my property, I will make the buyer aware of the Back�vater <br />Prevention Device and the need to maintain it. <br />Choose one of the following: <br />❑ As of now, rny property has no downspouts or oUier onsite drainage lhat connects to <br />the side sewer upstrearn of the insialled Back�valer Preven;ion Oevice. <br />or <br />;��II have dotvnspouts or other onsite drainage ihat connecls lo the side sewer <br />upstream of the mstelled I3ackwater Prevention Device. I understand that leaving these <br />connections means that the risk of flooding from downspout or onsite drainage remains. <br />I accepl that risk. <br />/.---� -% <br />Signat Date / <br />{'age 7 ot 2 <br />Revised 09109l2014 <br />