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���11,� , <br />�7l�nSe �ll f"��S o�%� or�d cst,� .,5 wi,a.� .,�ov� dc�1e � <br />W,¢. ..,�� 1 v-a,e.�- �,�: � N. yo,.. 1-o p�c.k if- �f �Q� stiy..� ,�u Itia�' � Qwv <br />BACKWATER PREVENTIQN DEVI�E FINAL <br />E�,;- INSTALLATiON G{-IE�KLIST <br />� <br />In<t'aVafinn Company Name and Cont2ct Info: �. <br />Date Back�valer Prevenlion device (DWD) was insta <br />Insiallation Property O�vner Name and Contact Info: <br />Property Address: �� Q ��k �1 � e <br />1 <br />Dale this form was compleled:_= <br />Pre-Installation Inspection Checklist: <br />A!i -fems must be ch,acked 'Yes' in order for a BWD to be considered /or insfailation <br />Is ;;.zre a basem��n' or le��el of the house that is at or near assumed sewer main eleva;ion7 [+�Yes ❑ No <br />Are tnere fxlures in the house located belo��� the upstream setver manhole rim elevafion'? [�'es C No <br />Is Ihe side searer currenUy UNPROTECTEa from se�,�er bacr.ups (does not have a BUt'D insf211ed)7 �i�-"i'es ❑ No <br />Site Inspection I;hecklisf: <br />Fi; ilems mest be check�d 'Yes' pefore insper.tion is r,onsrderad complste_ ._ _..__— <br />V;'as side sewer ll/ inspected trom buildiny to sev�er maia? [�'�es ❑ No Condition: <br />Does side sewer have at leasl 1°/a slope.from Ihe build!ng to se�ver main? [�Yes ❑ N,o Descrioe <br />iia.e all bullding se�ver drain connections to the sid � sewer been identifed and located? � res ❑ No <br />Have all properfy slorm drainage conncciic�,s to lhe side sewer been identified and locaied? []"Ses ❑ No <br />Has property been evaluated for drair�age deficiencies �vith findings communicated lo properiy o�vner7 [�'�(es ❑ No <br />Installation Uetails: <br />�;';4�a1 type and br�nd of BWD veas installed at this site (Clea� Check BWV, Grinder puni�, elc.). Sl2a/n Che�,� y_' <br />Vihere �vas/t�he device ins1falled (general descrip�ion, allach map)7 �0.si� S�dE cr� U�use l� b_g��7.n_rc�� <br />IA. �Fi(OWCr �"1C��I _ __ _ <br />1^;'as lhere any olher se��ver or storm drainage tivork completed in conjunction �vith lhe BIND �vork? Is so pl.ase desr.ribe: _� <br />Installation Checklist: <br />A�e ail doamspouls and site drainage disconnecled (roin upsiream o( lhe BWD? [�i 'e �! � No (=umm,enls: <br />Dr,es E�WU positiuning meets minimum slope reyuirement of >1 io7 [vf'�es ❑ No Comrnen(s: <br />Can BWD be pull�.d out tor inspection and maintenance aifer looseniny thumb screw? L�1 Yes [ � No <br />Is BNID locketl inlo the prope� positioo and thumb sr,rew tightened? 'es ❑ No <br />Cir�:le fhe 41NG cover. irr�al+s�eaver{+r�n_�sea�rea)1 traff,c load bearing cover (drive surface) ! ar,cess hatch (building) <br />�Ewr 2 Goven <br />!4�as property o�vner shovm Ihe loca(ioyvo�,mP'�istalled B�ND7 [�es ❑ No Commenis _ <br />Preperty Owner's Sic <br />t.. _ _ — -- -- <br />Insfalie�'s Signalure: <br />ftevision: � <br />Da(e:' �/' � � � <br />�.. .. <br />Date: �Z- �e/rS' <br />P,1onday, September 15, 2014 <br />3 f.H j l Y ui.' Y'T'Qlr4 '� ri��' t ,.X �•; --- ��frN.ww'.^•'^' .�: ,:...,—wun��f++��qy+.i�� - <br />_ .�� ��YYLY�..i �.f' _....'a/1R•X� %��Llit�i_� �u.it.n. . ...uv.. _�v� - A��JM�'N�/_�u.. . . <br />