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BACKWATER PREVENTION DEVICE FINA�. <br /> �, INSTALLATION CHECKLIST <br /> Installalion Company Name anc Contacl Info: i�� ���✓t� �/"� `1 �-� ` V� � � � 9 ��Z 3 <br /> Date Backr�aler Prevenlion device (BWD)was installed: 3��,1'`� S Date ihis for�ro was comp!eted: �-�� �5 <br /> Instal'ation Property O�v�er Name and Cont2ct Info. _ I ��•✓! �vti. �� o�e in'Z o'� J- 3�� - 2`� �' � <br /> PropeRy Address: 17 2-v � ��'''` �`'`Vd ��� ����� <br /> Pre•Instailation Inspection Checklist: <br /> All items must be checked 'Yes'in order(or a BtND to be cnnsidered fa installation <br /> Is there a basement or level of the house thal is at ur�,;:r assumed se�,�er main elevation? [�� ❑ No <br /> Are there fixtures in ihe house 'ocated belav the� " : �m sevrer manhole rim elevalion? �� ❑ No <br /> Is the side se�ver currently UNFROTECTED(rom se���er backups (does not have a BWD installed)% �� ❑ ho <br /> Site Inspection Checklist: <br /> AII items musf be checked'Yes'be'ore inspection is considered camp!efe (Nt <br /> bVas side sewer TV inspecled from building ro se��ver c�ain7 es ❑ No Condition: �✓� 5���� <br /> Does side sevder h2ve at least 1% slope from the building to sewer main? es ❑ No Describe: <br /> Have all building se�ver d�ain conneclions to Ihe side se�ver been identifed and located7 �'f2s ❑ No <br /> Have all property storm drainage connections to the side sev.�er been identified and localed? ��'8s ❑ No <br /> Has prop�rly been evaluated for drainage deficiencies with findings communicated to property o�.meR [�a'es ❑ No <br /> Installation Getalls: n ���`C��� <br /> 'Nhat type antl brand of BWD was ins(alled at this sile (Clean Check B�N/�V, Grinder pump, etc.): (�= <br /> Wnere was ihe dcvice installed(general description, attach map)? 1�'�`-� �-1 � � �.� <br /> lNas there any other sewer or storm �rainage tivpr;K completed in conjunclion wilh ihe BUJD v�ork? Is so please descrihe:_ <br /> �� CJl�L.` <br /> Installation Checklist: <br /> Are all dar:nspouts and sile drainage disconnected from upstream of the BWD9 ��'e.s ❑ No Comments: n�"`� <br /> Does BWD positioning meets minimum slope requirement of>1%? [a�es ❑ No Comments: _ <br /> Can B�ND be pulled out for inspection and maintenance afler loosening thumb screw7 o-l'es ❑ No <br /> Is BUJD lockec! mto the proaer position and screw fightened? � es ❑ No <br /> Circie the BWD cover: irrigation cov Qandscape a �traffc load bearing cover(drive surface) I access hatch (buildiny) <br /> Was property owner shown ihe localion of the inslailed BWD? ['�� ❑ No Commenis: <br /> PropertyUwner'sSignatur�U"""- -- � Date: 3 �bJ- � S <br /> Inslaller's 5ignature: /' .'�/ Date: 3—� Q/- � � <br /> Revision: 2 1 friday, September 12, 2014 <br />