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BACKWATEF2 PREVENTIOiV DEVICE FINAL <br />INSTAL.LATION GHECKLIST <br />Installation Company tdame and Contact Info�. <br />Dale Ba.:kv;ater Prevention dev�;,e (BNlD) �vas <br />, ,� <br />s Da!e th's'erm was compLted:. i" ������� <br />Installatian Property Owner Name and Contact Info:M f� � 0.C� 1�_ �"S� _ — <br />ProperlyAddress: 3��� It�YI ��� — — <br />Pre•Installation Inspection Checklist: <br />All items m!�st be checV.ed'Yes' in oraer for a BV✓D to he considered for insta!lation <br />Is tnere a basemen' or le��el of the house that is at or near assumed seeder main elevalion? _, es ❑ No <br />Are there fixtures in the house located belo�v the upstream se���er manhole rim elevalion? Yes ❑ No <br />Is tne side sevrer currently UNPROTECTED from sewer 6ackups (does not have a BWD ins?alled}? [� Yes ❑ No <br />Site Inspection Checklist: <br />Afl items must be chFched'Ves' before insoection is considered omplete <br />VJas side se�ver N inspecled irom building to sewer main? Yes ❑ No Condilion: <br />Does side see�er have at least i°o Slope irom tfie building to se�v2r ntnin7 � Yes ❑ �'o DescrSe: _ <br />Haee all building sewer drain connections fo ihe side sev.�er �een idenlified and located? � Y s❑ IJo <br />Have all propErty Slorm drainage connecticns to the side sewer been ideniiiied and locatetl? � Yes �o <br />Has property been evaluated for drainage deficiencies tvith findmgs communioated to property owner? � Yes ❑ Nn <br />Instaliation Oetails: �-���S�a <br />What type and hrand of 81ND �vas installed at this sil lean Ch -. aWV, Grinder pu p, etc.): _ __ <br />Where �vas the device installed (general clescription, atlach map)? ��%� ` _._ 1�a�_ <br />Was Ihere any other sewer or stnrm draina�e e�ork completed in conjunclion �vilh the Bl'JD tvork? Is so p'ease desr,rihe:!�� <br />Installation Checklist: <br />Nre all do�vnspouts and site drainage disconnectetl irom upstream of ih� BWD7 <br />Yes ❑ No Comme;us: <br />Does BWD positioning meels minimum slope requiremenl oi>t%? � Yes ❑ IJo C mmenls <br />C�n BUVD be puiled cut tor inspec6on and ma�ntenance after loosening trumb s�re�v? ��Yes ❑ No <br />Is BWD locked into the proper positio od�inuu w tighlened? �'Yes ❑ No <br />Circle ihe BWD cove irriga(ion cover landsca e area 'traffc load earing cover (drive sur{ace)! accass hatch (builiiinq) <br />�Vas property ovmer shov.n the locafion of Ihe inslalled 4lND? [ Yes ❑ tJo Comments: <br />Date: ��r,��j%�0(� <br />rroperty Owner's Signalure i — <br />Ins!atler's Signature: _Z��t,L� C� U/ Date: 1� a���'�. <br />Revision: Z 1 MonJay, September 15, 2014 <br />