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BACKWATER PREVENTION DEVICE FINAL <br />INSTALLATION CHECKLIST <br />Irstalla:ion Company Name and Crn[act Info:,�� /o ' _. <br />Cate Baclnvaler PrevenUon device (B1ND) v�as installed: (c% Dale this form was completed: 3����-f <br />Installation Property Owner Name and Contact In(o: ' �ri yt �tr ±4fr_-_ .��'"�r•:��� h��✓%r��� S <br />Pro; ��rly Address: ,� � � ""? f� Yr _ — <br />Prx•Installation Inspection Checklist: <br />All items must be checked 'Yes' in order (or a BWD fo be considered (or instaflafion <br />Is there a basement or level of ihe house that is at or near assumed sewer main elevation? Yes � No <br />Are there fixtures �n the house located below the upstream se.ver manhole nm elevation7 ' Yes 'i] No <br />Is lhe side sewer currently UNPROTECTED fram se'e�er backups (dces rof have a BV'JD inst2!led)? � Yes ❑ P;o <br />Site Inspectfon Checklist: <br />All items must bo checked 'Yes' betore inspecUon is considered complete <br />Was side sewer N inspecled from building to sewer main7 �Yes ❑ No Condilion. _ <br />Does side sewer have at least 1% slope from the building to sewer main7 � Yes ❑ No ��escribe: <br />Have all building sewer drain connections to Ihe side sewer been Identified and Iocaled? �Yes ❑ No <br />Have all property slorm drainage connections to thP side sev+er Ceen iden6f.ed and located? � Ycs ❑ No <br />Has property been evaluated for drainage deficiencies with findings communicated to property owe,�� ,[�j Yos ❑ No <br />Installalion Oetalis: <br />What type and brand of BWD v,as installed at this sit ea eck , Grinder pump, elc.): <br />Where was the device inslalletl (generai descnption, ac i map17 _. <br />,i . � �.. <br />Was there any other sewer or slorm drainage worR compteted in conjunclion with Ihe BW� work? Is so please describe: _ <br />Installatian Checklist: <br />Are all downspouls and site drainage disconnected irom upsiream of Ihe BWD1 �Yes ❑ No Comments: <br />Does 8WD posiGoning meets minimum slope requirement of>1%7 j�Yes ❑ No Commen;s __ <br />Can BNJD 6e pulled out far inspecUon and maintenanr.e after loosening ihumb screw? � Yes ❑ No <br />Is BWD locked into the proper posilion and thumb screw lightened? [� Yes ❑ No <br />Circle the BWD cover. irtigation cover (landscape area�tfaffic foad bearing cover (drive surtace 1 a ess hatch (build�eg) <br />Was property owner shown ihe localion of ihe installed BW�7 �Yes ❑ No Commens: __ <br />Property 4wners Signatu �` � n � •1S�,�c�z���.%�_ Date: 3�l /i.� <br />Installcrs Signatu Dale: ���.� _ <br />Revision: 2 <br />Friday, Septr_mber 12, 2014 <br />