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BACKWATER P6tEVENTION DEViCE FINAL <br /> INSTALLATOON CHECKLtST <br /> Inslallation Company Name and Contact Info:�-�- l��u,�r:-��l�`�, ��� � �- ��� �2 3 <br /> Date Backvraler P�evenbon device(8WD)wes installed: 3-1 - `3,Date this form wes completed: �'- ��'-�r <br /> 1, a vC�- -�,t-t�rr <br /> Instellation Property Owner Name and Contact Info:_(6 �Z �� �'�a�- l 1 ���� <br /> Frc,perry aadress: �K o Z �uM �Javd <br /> Pre-Installation inspection Checklis� <br /> All 8ems must De checked'Yes'in order for a BWD to be considered forinstalletion <br /> Is there a basement or level of the house that is at or near assumed sewer main elevation7�y�res ❑ No <br /> Are thete fixtures In the house located below ihe upstteam sewer manhr�le rim e;evationl�, �No <br /> Is ihe side sewer currently UNPROTECTED frnm s,�wer bac!cups(d�,x;s not have a i�WD Installed)?[��s ❑No <br /> Site Inspection Checklist; <br /> All items must 6e checked'Yes'before tnspection is considered con;olet� � � ��/ ��S <br /> Was side sewer N inspectsd from building to sewer main7 [�e�❑ <br /> No Condition: "" -�- <br /> Dces side sewer have ai least 1%slope from the building to se�ver main? [�`es ❑No Describe: <br /> Haue all building sewer drain wn�e�lions to the slde sewer been idenUfied and located? [�]Yes � No <br /> Have all property st�rtn drainaga connections to th�side sewer been ideniified and losated7 [(�1'es ❑ No <br /> Has pr�perty heen evaluated(nr dralnage deficiencies with findings communicated to property o��vne� Qa`es ❑No <br /> Installation Detalls: � �,�1,(��� <br /> What type and brand of BWD was inslalled at this site( lean Check BWV 'nde�mp,etc.): <br /> Where�vas Ihe device fnstallod(general desaiption,attash map)7 — <br /> Was lhere any other sewer ot stortn drainage twrk co�pleted�nC njunetion with ihe BWD vrorlCl Is so please describe:_ <br /> l/ <br /> Instalfation Checklist: ,�,,/ <br /> Are all downspouts and site drainsge disconnecled from upstream of,i.h.,�e�B�/WD? l�-t'ras �No Commenis: _ <br /> Does BVJD posiaoning meets mininum slope requiremenl of>t%? L4'fes �No Comments: _ <br /> Can BWD be pul�ed out tor inspection and maintenance aRer foasening thumb screvl? [�a`� ❑No <br /> Is BWD locked(nto lhe proper position and lhumb screw tightened? es ❑Nn <br /> Citr,{e ihe gWD cover.irtigation cover(landscape area ffic load bearing cov r(driue surface)/access hatch(building) <br /> Was properhj owner shown the location of the inslalled BWD? �1 �.s �y�wo �0mments:���— <br /> Property O�me�s Signatu � f3 <br /> 14-1�s�F�jy Date: �-� /�-�� <br /> Installers Signature: <br /> ���'��L— Date: �j— l 9�!,� — <br /> Revision:2 1 Friday,Septem6er 12,2014 <br />