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, . . ,,• . <br /> BACKWATER PREVENTION �J�VICE FINAL <br /> INSTAI_LATION CNECKLIST <br /> Inslallation Company Name and Contacl Info:SA�'�'1 P��Li�S �P�-V�1��� I�l!(� , � N ( . <br /> Date Ba�k�vater Prevenlion device(�:^,'J)was installed: 2�1 � 1 S Dafe this (orm w2s campleted: Z L C{ 1 S <br /> Ins(zllation Property Owner Name and Contact In(o: _ L--�� c?w�S ' �`LS Z'S�1 2-1��P _ <br /> Property Nddress: �h 3�_ L.�.^. ��,,,rc� 4��������, <br /> ' , Pre-Installation Inspection Checkiist: <br /> NII items must oe checked 'Yes'in order for a BWD fo be considered(or insfallafion <br /> Is there a basement or level of the house that is at or near assumed see�er main elevation? [ Yes ❑ No <br /> tire Ihere fixiures in the house localed below lhe upsirearn sewer manhole rim elevation? �Yes ❑ Nq <br /> Is �ne side sev�er currsnt'; UNPROTECTED irom sewer backups (does not have a BWD installed)7 �es ❑ No <br /> Site Inspection Checklist: <br /> A!I irems must ue checked 'Yes'before inspection is considered co nlete <br /> l4�as side sewer N inspecled from building to sewer main? C�s ❑No Condifion <br /> Dces side sev�er have ai least 1%slope from the buildina lo sewer main? �es ❑ No Describe: <br /> Have all builtling sewerdrain connections lo the side sewer been identified and located? [J Ye /❑ No <br /> fiave al! property stor.m dra�nage wnn�ctions to the sitle se�ver beer� identifed and located? -(t�Yss$idq /V/v T _ <br /> Has property been evalualed (or drainage defciencies vrith findings communicated lo property ovmer� [�es ❑ No <br /> Installation Details: ,��T <br /> UVhat lypr and brantl ot f3WD was inslalled al Ihis�SiCe(C1ean Chec .B�'dV, Grind�r pump, etc.�: Q�e����vc.,� <br /> I�vhere v;/as ihe de/v�ic�e installed (general dessription aflar.hinap). 1x1.dk o�-�/�i� U v a�es ,r�c��__ <br /> �t/S �/- �(°.�"l� rJ•� �"/�?.L� ' Or ��q �i' (�_�OT �' OunC.��L'F+O✓1 <br /> Was Ihere any other se�v�r or storm drainaye 4vork completed in conj�.mc�ion with the BWD e✓ork'? Is so plezse describe:_�� <br /> Installation Checklist: <br /> Are all downspouls and sile drainage disconnected (rom upstream o(the BIND'? Yes ❑ No Comrnents: __ .__ <br /> Uoes BVVD positioning meeis minimum slope requiremen�of>t%? ( I Yes ❑ No C�/orr�ments: <br /> Can E3WD he pulled out lor inspeclion and maintenanee a(Ier loosening ih mb screev? [V�Yes ❑ No <br /> Is 13WD locked into the proper position and thumb screvr tiyhlened? ✓ Yes ❑ No <br /> S�Q.�^�.:r- �0v E.✓' <br /> Circle the BWD cover. i - < < � �c-4s���ri�� _ , eh-fyniiging) <br /> Udas property o�vner sho�.��n lhe location o(lhe installed BWD? [V]'�es ❑ No Commenis: <br /> _ � �, -� <br /> . -' ProF�ei(y�0�vner's Sig�afure: �� �../ � Dafe: 2�2 /�/S <br /> - r <br /> Installer's Signature: - .� , �jr,-�_ Dale: 2- /k - / __ <br /> Revision� : 1 Monday, September 15, 2014 <br />