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{ <br /> , <br /> � <br /> i <br /> � BACKWATER PREVEN710N DEVICE FINAL � <br /> INSTALLATION CHECKLIST � <br /> � <br /> instelletion Company Na�d anta`ct�ICn1o: 2lr� � <br /> Date badcwater device(BWD)wes installed: �--��-� � Date th's lam was aompleled: ' � - i <br /> 5 � i <br /> Installation Property Umer Name and Contad Inlo: � <br /> � i <br /> Prope�ty Address: � <br /> PrNn�tallation inspection CAeckliel: ; <br /> AN ifems musf 6e checkoaf'Yes'in aderlor a AWD fo be considered(a insfalla(ion <br /> Is fhere a hasemenl or level 01 tt�e house thal is al a near assumed sewe�main eleva6on�Yes ❑No � <br /> Are Nere fizlures in Ihe Aouse located bebw the upstream sewer manhole rim eleva6on7 Yes ❑No � <br /> Is the side sewer artently UNPROTECTED hom sewer had�ups(does not have a BWD installed)7(a'Yes ❑No ; <br /> SAe Inspectian CAakliet: <br /> 1 <br /> AOifems must be cAecked'Ves'before inspection is considered plefe <br /> Was side sewer N inspected from building to sewer mai��7 �es ❑Nc CqndiUon: <br /> Does side sewer have al leasl t°,6 slope Irom ihe bui{ding to sewer main9 �Yas ❑No Desai6e: � <br /> Have ell 6uilding sewer drain connections to the side sawer been idenlfied and located? �Yes ❑No i <br /> Have all praperty storm�ainage connections to the side sex�er been identfied and bcated� (�Yes ❑No � <br /> Has property 6een eveluatad for drainage defidendes with findings cammunicated lo property owne� �Yes ❑No � <br /> Ins1�11aUon Defalls: ; <br /> Whal type and hrand oi BWD was inslalled at Ihis sile(Clean Chedc BWV Grin er pump,atc.): i <br /> Where was Ihe device iaslalled(generai desaiption,attach map)? � <br /> W there ny other sew�or stortn dra' age woik mpleted in co �unctio wilh tl�e A WD work?Is pl aibe: <br /> �i�cn sQ��� �.r� -��t..� s�,na 2 f-� �,+�oo� �"�v�Do � <br /> InelallaUon ChecklleL• f � <br /> Are ell downspouts and sile drainege disoonnecled han upstream o(Ihe BWD7�Yes ❑No Commenh: � <br /> i <br /> Does BWV posi6oning meet minimum slopa requirement ol>t°,b� �es ❑No Comments: <br /> Can BNN be pulled oul tor inspedion and maintenance afler loosening umb saexR �Yes ❑No <br /> Is BNN locked into Me proper positian and thumb saew fightaned7 �Yes ❑No • <br /> Cirde Ihe BVW cover: irrigation cover(landswpa area)I tralfic load 6earing cover(drive surface)I access halch(building) <br /> i <br /> Was homeowner shown Ihe location of the installed ABWDT ��Yes ❑No Comments: I <br /> 5 �. ; <br /> Property avner's SSnaN • Date� �� '/S <br /> Inslallers Signatm�i: _ Date:��— f�'� ' <br /> i <br /> Revision�2 � 1 Thursday,Octobcr 02,2014 <br /> i <br /> � <br /> _ _ � <br /> 1 <br /> i � <br /> - — i <br />