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��� L3ACKWATER PREVENTION DEVICE FINAL. <br /> � INSTALLATION CHECKLIST <br /> Inslallation Cor�pany N�ime and Confacf Infor���t�y�2 CetVSir�circ,�let�Acc.J�1`'�Z5_S�S `Z�� <br /> Da(e Backvaater Prevenlion device (BVJD) vras insi;illci! �j17�JSJ f);ilr. Ihis lur�n w;r; cnniplcl���l: �'/ � �7 �.5 <br /> _ �_l � <br /> Instaliation Preperty O,vner fJame and Contacl Inlo ��crl� P�LC__ <br /> ---—— --.. _.-- -- <br /> PropertyAddress: >''�g L��?r3�t-2� <br /> Pre•Installation Inspection Checklist: <br /> Ail item�must be chccked'Ycs'in otder lor a FWD lo 8e r.onsidcred(or inslallalion <br /> Is there a basement or level o(the house ihat is at or near assunicd sewcr main r.levalio�7 I"�Ycs � � PJn <br /> Are there fixlures in the house located below the upsfream sca+cr mvihnle rim r.lr.va�ion7��`f�Y��s � � No <br /> Is the side sewer currenlly UNPROTECTED (rom se�,vcr backups (docs nol have a f3�,ND inslalled)7 �"r'es � ]f;o <br /> Site Inspection Checklist: <br /> All rtems musi be checked 'Yes'be(ore inspeclion is considered cornN'elc <br /> Was side sevier N inspected trom building �o sewer main? ��}-Ye�� � J rao Condifion ____ _ __ ___ <br /> Does side sev,er have a( Icast 1%slepe from the building lo sea�cr main? [�Yes � J iJo Desciiba. <br /> - — - — -_ <br /> Have all building sr.wer Arain connec6ons to thc side sewer hren idcnfified and lor,aied'? � �J'`(cs �. J Nu <br /> Have all property slorrn drainage connections to ihe side sr.v✓er been idenli(ied and localed? �_'�"Yr,s ( � n'o <br /> Has propCrty been evalualed for drainage deficiencies wilf;lin�hngs cuin�nunicaled lo pruperly nwn��i7 � �'j 1'es ( f Nu <br /> Installation Details: <br /> What type and brand of 6WD�vas instaUed at tnis site (Clcan Check QWV, Gnnder pump,r.lr. ): C�rh'N G1���� <br /> INi;ere ;vas fhe device inslalled(generai description, al(acli map)7 � , ,D� � o,G `'S'�o•« l3�UL <br /> C.'e,2,�e� <br /> � —�-- -- — <br /> 11�as there any olher sewer or sfonn drainage work compleled in conjunr.tion with Ihe BWD work? Is so picasc describc <br /> Installation ChecklisL• � <br /> Are all downspouis and sile drainage discunnecled from upslrr.am of(he BWD? ��es � � No Cumni��nls. <br /> Does 4WD posiliuning mecls minimum slopc requiremeN ol >1`%"l � �'Yi's �__� Nu Cnmmenls <br /> C�n RNJ� bc pullcri uul (nr inspr.clion and mair�enanr,c ;dlcr luusr.niny Ihwnb sr,rcrl� � ✓"Yc', � � PJ�, --- <br /> Is BWD Inr.ked inlo Ihe p:oper pnsition and Ihumb s� �• i\�hlenr.d'� �'�"�es � � Nu <br /> Cirde �he f3WD �ovei. iuiyrdion c er land�c• e area Ir�llhr.lo�tl beanng r,ovr.r (drive si:�l;ice) /;ic���;;hnlrh (huil�l nq) <br /> Was �uo��r.rty u�vnci shu��vn fhi:�lo�ation o(�he inslallcd fIWU? ��I res � � No Cuinnus�is <br /> Prop��ily l)wncr's Siqn�dur �. ----- U,ilc gl�S / Zpl 5—' <br /> /jJ.._ f_ . - — � <br /> Insi:dL•� :: :;i�pi,iiun ?�iJX(4 --Ll.,�.�--_ . _ fkq�� J/Zr/ <br /> �� �� <br /> Rer-.i.��i . I fhlnnrLi)�. `•i•�il��iiiln•i I'� .'nl i <br />