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, • <br /> IBACKWVATER PREVENTIC�N DEUICE FINAL <br /> E� INSTALLATION CHECKLIS �T <br /> Irs(allation Company Name and Contad Info: � �a��'1 I�('7� LL�S ��-l./�1�� Iti!(� �N i . _ <br /> Date Backwater Prevenlion device (BVdD)tivas inslalled: 1 a �6 Date this form was completed: l J /S <br /> Instal:alion Propsrty Owner Name and Contact Irio: , �Va�� c,1,.��5��� <br /> Property Address:�Q S . I UM��b � �� �' �'lK� _ <br /> Pre•Installation Inspection Checklist: <br /> l;11 r;ems musi be checked'Yes'in order Ior a BWD to be cons;dered for installation �� <br /> Is tn�re a basement or IeJel of the housa that is at or near assumed sewer main elevation? �i Yes ❑ No <br /> Are Ihere (ixlures i�ihe house localed 'oelov�1he upslream sevrer manhole rim elevation? �es ❑ No <br /> Is!he side sea;er cu«ently UNPROTECTED �,�m sev�er backups (does not have a BIND inslalletl)? (�Yes ❑ No <br /> Site Inspection Checklist: <br /> .� •� <br /> ` ,'i;l ieems'musf be checked 'Yes'before inspectiorr is cansidered complete <br /> vvas side se�oer.TV inspected from building lo sewer main? �es ❑ No Condition: _ <br /> ,.:. <br /> Does side sewer have at least 1°/o slope from the buitding to sewer main? [�'�s ❑ No Desciibe: <br /> ;ave all building se�ver drain conneciions lo the side sewer been identiiied and located? �es ❑ No <br /> t iave all property storm drainage conneclions lo lhe side sewer been identified and located? [�Yes ❑ No <br /> Has properiy been evaluated for drainage deficiencies e,�ifh findings communicated to property owner? �es ❑ �do <br /> Installation Details: <br /> !�1�hai lype and brand of BN'D was installed at this s .e(Ciean Check BWV, � rinder pump, etc.): __ <br /> '�;;'here was tha device insfalled (general descriplion, ttach map).' _ <br /> ';'!'as Iheie any other sewer or storm drainage work completed in conjunction;vith ihe BVdD work? Is so please descrihe ��c7 <br /> Installation Checklist: <br /> ;�.re all do�vnspouts and site drainaoe disconnected from upslream of the 8W0? ❑ Yes �o Cemmenis:____ <br /> Does BUVD positioning meels minimum slope requirement of>1%? �Yes ❑ No Com ents: <br /> Can BWD be pulled ouf tor inspection and maintenance aEter loosening Ihumb screw? Yes ❑ No <br /> Is BWD locked into the xo er position and thumb screwlightened? 'es ❑ No � `��. C���� <br /> Circle lhe BUVD cover imgation cover(landscape area /Iraffic load aring cover(driva surface)/access hatch (building) <br /> V:�as properiy owner shown ihe Inca ion of ihe insfalled BIND? Yes ❑ No Comments: <br /> Property Ov,�ner's SignaWre: � , /� � Dale:t ���o /� !S <br /> Inslaller's Signature: �".,., __C__,��e✓! Date:_2 i G S <br /> y <br /> Hevisior�: ? 1 Monday, September 15, �014 ' <br />