1032 E MARINE VIEW DR 2022-05-02

! BACKWATER PREVENTION DEVICE FINAL � INSTALLATION CFIECKLIST j ; � Installation Company Name and Contact Info:,/�,�odo !�G,.�71r ��s � Date Back�vater Prevention device (BWD)was instailed: Dale this form was compieted: � Installation Property Owner Name and Contact Info: ��r��. L✓oo�7 ��/�-3�-✓/ ! � ProperlyAddress: /�3� i' � -��•�c V 'ev r� � Pre•Installation Inspection ChecklisL• ': All rtems musf be checked'Yes'in order(or a 8WD fo 6e considered lor rnsfallafron � Is there a basement or level of tne house lhat is at or near assumed sewer nain elevation?❑Yes ❑No ; Are there flxtures in the house located below the upstream sewer manhole rim elevation7❑Yes ❑No � Is the side sewer currently UNPROTECTED from sewe;�ackups(does not have a BWD installed)?❑ Yes ❑No � Site Inspection Checklist: ' Ali items must be checked'Yes'before inspection is considered complete � Was slde sewer N inspected irem building to sewer main7 ❑Yes ❑No Condition: � Does side se�ver have at least 1%siope from the building to sewer main? ❑Yes ❑No Describe: � Have all building sewer drain connections to the side sewer been identified and locatedl ❑Yes ❑ No Have all property slorm drainage connec6ons to lhe side sewer 6een identified and located7 ❑Yes ❑�o � , Has property been evaluated for drainage defcienc:es with findings communicated to property ov+nar9 ❑Yes ❑No Installation Oetails: � What lype and brand oi BWD was installed at this site(CIe3n Check BVW, Grinder pump,elc.): Where was the device Installed(general descriplion, atlach map)? VJas there any other sewer or storm drainage work completed in conjunction with lhe 8WD work?Is so please describe:_ � Installation Checklist; ' Are all aownspouls and site drainage disconnected irom upslream oi ihe BWD7 ❑Yes ❑No Commenls: Does BWD posiGoni�g meets minimum slope requiremenl of>t'b1 ❑Yes ❑ No Comments: ' Can BWD be pulled ou1 for inspection and mainlenance after loosening thumb screw7 ❑Yes ❑No � Is 8WD locked into the proper posAion and thumb screw tightened7 ❑Yes ❑No � Circle the BWD cover:irtigation cover(landscape area)1 Va�c load bearing cover(drive sur(ace)I access halch(bullding) � Was property owner shown the loptio he inst Iled WD? ❑�s ❑No Commenls: �� �,/ � Property0wnersSigna G o"J �ate: Z/`��/� ; Installers Signalur,� � Dale; l �I�/S'� � t Revision: 2 1 Friday,Septem6er 12, 2014 � j ;