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i <br /> � <br /> �ACKWATER PREVENTION DEVICE FINAL � <br /> IN�TALLATION CHECKLIST � <br /> i <br /> ,� � I � <br /> Installation Company Name and Ccn;act info: '.'-Nl i ��tVJ�h 1�lL� ; <br /> �,r I <br /> Date Ba�Mvaler Preventicn aevice (BWD)was installed:_ 5%��� �S_Dafe this(orm was completed: Gl I Z -�5- _ I <br /> InstallationPropertyO�,vneriVameandContactln(o: ��;v� �ojc�w�c��n . <br /> Property Address: �30� +-{{��.� � � <br /> � <br /> Pre-Installation Inspection Checklist: i <br /> All ilems must be checked 'Yes'in crderlor a BIND to be cons:dered lor installa!ion ' <br /> Is there a 6asement or level of the house that is at or near assumed seerer main elevation? f� Yes ❑ Nn ; <br /> Are there fixlures in the nouse located belcw the ups;ream sev�er manho�e rim elevation?I� Y�s ❑ No i <br /> Is the side sewer currently UNPROTECTED from szwer backups (does nc,have a B'rJD installed)? � Yes ❑ �o ; <br /> Sile Inspection Checklist: � <br /> Ail items must be checked 'Yes'6e(ore inspection is consider?d complete ; <br /> lNas side sewer N insFected from building to sewer main? �I Yes ❑ No Condilion: j <br /> Dces side se�;er have at leasf 1% slope from the buiiding to se�rrer main? [�Yes ❑ No Describe: � <br /> Have zll building sew�r drain connections lo the side sewer�een identified and located? �]Yes ❑ No ', <br /> Have all oroperty storm drainage cennections to Ihe side setiver been identified and located? [j�Yes ❑ No <br /> Has property been evaluzfed �or drainage deficien��ies v�i'h flndings communicated to properly owner? �Yes ❑ No � <br /> Installation De!ails: � <br /> l'Jnat lype and brand o(BVUD was installed at this s �C!ean Che��er pump,etc.): _ <br /> LVhere�v�s ihe device installed (general description, attach map)? ' LS,q cv� ; <br /> � �f >tu&�11� � <br /> ',Vas fhere sny other se:ver or slonn drainage wirk cpmpleted in conjunction vrifh the B�UD work? Is so please describe: _ ! <br /> /J � <br /> Installation Checklist: <br /> Are ah do�vnspouts and site drainage disconnected from upstream o(the BWD? � Yes ❑No Commenis�. � <br /> Does BbVD positioning meefs mfiimum slope requirement o(�1%? {�Yes ❑No Commenis: <br /> Can BIND be pulled oul(or inspection and maintenance after loaserin thumb screw? ��Yes ❑ No <br /> Is BVVD locked into Ihe pro et_pasition a�fnum , �e ligMened? �] Yes ❑ No <br /> �ircle Uie BWD cov : irrigalion cover landsca e ar `affic load bearing cnver(drive surface};access hatch (building) <br /> Was properly o�mer shotivn the locafion of thc installed EWD? �Yes ❑ No Comments: <br /> Prcperty Owner's Signalure: � Date: � <br /> Installer's Signature:_�_ � Date:� - � Z ' 1 S __ � <br /> Revislen: 1 l I riday,Sep;ember]J, 2014 . <br />