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BACKWATER PR�VENTION DEVICE FlNAL <br />INSThLLAiION CHECKLISIf <br />�'►�'ri c�zr� <br />i�stailation Company Name and Conlacl <br />c <br />`�"�de �c�ic��-, � <br />Date Backtvater Prevention device (BVJp) �vas ins(alled: �7 l _ Date this form tivas compleled:�_ <br />Installation Properiy Owner Name and Contact Info: �,��L �'� ��� y-�c�,-� /.{ a� .- ��/��_ _�.; ,, <br />Property Address: <br />;U:£-F �i �': <br />Pre-Instaliaticn Inspection Checklist: <br />All items musf be checked 'Yes' in order lor a B!✓D to be considered (or instaqafion <br />Is there a basement or levef of ine house that is zt or near assumed sewer main elevaticn? [�es [] No <br />Are there `ixtures in ihe house icca!ed belov✓ (he upsiream se:ver manhole rim eleva6on? [�-Yes ❑ No <br />Is the side sewe� r,�rrenlly UNPROTEC7ED from sewer backups (does no; have a BWD installedJ? �Yes ❑ �Vo <br />Site Inspection Checklist: <br />All items must 6e checked `Yes' 6efere inspection is consrdered complete <br />l-+1as side se�ver TV inspected irom building to see�er main? �Yr,s _� <br />❑ No Condition: � _ __ <br />Does side se�ver have at teast 1°,o slope fram tne building to sevder main? [�%Ycs ❑ No Descrihe: <br />Have all buiiding se�ver drain connec(ions to the side se�ver been idenfified and located? [�kYes ❑ No <br />�lave all propert, slorm drainaae connectiors lo ti�e side se�ver been identified and located? �1�Yes ❑ No <br />Has property been evaluated for drainage deficiencies �vith findings communicaled to property owner? (�Yes ❑ No <br />Instalfation Details: <br />VJha! type and brand of BWD was installed at this sife {C!ean Check BN�V, Grincer pump, etc.): _�� �� <br />lMhere tvas ihe device instalfed (general description, all;�ch rtiap)?, j�����I����1 � ��_S � u�+ <br />Was there any o(her setiver or slorm draina�e v;ork comp!ete�d, in/ conjunction v�ith Qie DWD vrork'1 is so please describe: <br />----- -- --�—v � � _ — <br />Installatlon Checklist: <br />Are ail do�enspouts antl sile drainage disconnecletl from upsfream of the 8WD? �-Yes ❑ No Commenfs: <br />Does BWD pcsitionrng mee(s minimum slope reqwreme�t of >i °io7 ,v Yes ❑ No Comments� <br />Can Bl^JD be pulied out for inspeclion and maintenan�e after loosening ihumb scre�v7 [�Yes ❑ No <br />Is BtND locked in(o the properposition and thum6 screw tightened? Q,Yes � N� ' <br />Circle the BI^1D cov�r, ung ial on cover (�idscape area) / traKc load beariny cover (tlrive surface) I access hatch {building) <br />Was property o�vner shotvn �I; aU"on of ihe instailetl BWD?�'Yes ❑ No Comments: <br />Prcperty ( <br />Inslaller's <br />Revision: : <br />Dafe: �G^�%�� <br />� __-__ <br />Date: �O - /9 - � � <br />ay, September 12, ?D14 <br />� <br />