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BACKWATE:R PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> installation Company Name and Contact Into:�l�JS��u�1� �"L'�M U��� �'y� y����� <br /> Date BacMvater Prevention device (BWD)wris instailed: �"��^OZm�s _Date this form e�as completed:_ `��'���-� <br /> Inslallafion Property Owner Name and Contact Info:,��n I� ��Z u o^�q �l.�S-�y�)- 9I y� <br /> Property Address:���,� iti1/�.� �Q- s - <br /> Pre•Installation Inspection Checklist: <br /> All ifems must be checked'Yes'in order for a BIND to 6e an�idered forinstallation <br /> Is there a basement or level of the house thal is at or near assumed sewer main elevation� Yes ❑ No <br /> Are there fixtures in the house located be�ow ihe upstream se�vzr manhole rim elevation? Yes ❑ No <br /> Is the side setver currently UNPROTECTED from sevaer backups(does not have a BVJD installed)?�Yes ❑ No <br /> Site Inspection Checklist: <br /> All items iiiust be checked'Yes'before inspection is considere�omplete <br /> Was side se�ver TV inspected from building to sewer main? Yes ❑ N�oJContlition: <br /> Does side sewer have at leasl 1%slope from the building to sewer main? lL/J Yes ❑ No Describe: <br /> Have all building sewer drain connections to ihe side sewer been identified and located? �Ye ❑ No <br /> Have all property storm drainage connections to the side sewer been identified and located? �Yes ❑No <br /> Has property been evaluated for drainage deficiencies with findings communicated to properfy owner? �Yes ❑ No � <br /> InstallationDetails: �C�R��/ i <br /> What type and brand ot BWD was installed at lhis sit Clean Che BWV, Grinder pump, elc.): � <br /> Wher�s the devi�ins,�1al�e,d(generai description,aflac i map)? � C� � � s �A s����� <br /> ��_lt�u �,�� <br /> Was there any other see�er or storm drainage work completed in conjunclion with tKe BVVD�•+ork? Is so please describe:�C7 I <br /> Installation Checklist: � <br /> /ve all dovmspou's and sile drainage disconnected irom upsUeam of th BWD? t[�Yes ❑ No Commenis: <br /> Does BWD positioning meels minimurr�slope requiremenf of>t%? �Yes ❑ No C imenls: <br /> Can BWD he pulletl out for inspection and maintenance aiter loosening humb screw? �Yes ❑ No <br /> Is BWD locked inio the pro er �osition anu th ib screw lightened? �Yes ❑ No i <br /> Circle the BWD cover irrigation cover(landscape area !traftic lo�bearing cover(drive surface)1 access halch(building) <br /> Was property ovmer shown the location o t e inslalled BWD? Yes ❑ No Comm2nts: <br /> Properly O��mer's Signature: �I ' Date: I'����-� ! <br /> 1 �� p �1 S � � <br /> InstaVers Signature: l�il�� ( ,�+.�2.� Date: �J s�� ' a�� <br /> Revision: 2 1 Monday,September 15,2014 <br />