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B.�CKWATER PREVENTION DEVICE FINAL <br />INSTALLATION CHECKLIST <br />Inslallation Company Name and Contacl Info: i'�`�" ����� ���� 1;�L �7 1� � h� ��- C <br />Date Backwater Prevention device (BWD) was <br />Installation Property Owner Name and Contact Info: <br />Property Address: <br />Date this torm was compleled: �l-7 ��-/ (~ <br />� , la . cn.-e.��- '7 �%ZCszTJ <br />Pre•Installalion Inspection Checklist: <br />AN items must be checked 'Yes' in order lor a 8WD fo be conside�ed lor instaflation <br />Is Ihere a basament or level o( the house th�l is at or near assumed sewer main elevation? [�]�`E3 ❑ No <br />Are there fixtures in lhe house tocated below the upslream sewer manhole rim eievalion? [� Yes ❑ No <br />Is the side sewc� currently UNPROTECTED from se�ver backups (dces nol have a 9WD ins�alled)� (C-�-Yes ❑ No <br />Site Inspection Checklisf: <br />All ifems musf be checked 'Yes' before inspection is considered complete ,n ,-� <br />Was side sewer TV inspecled from 6uilding to sewer main? es No Condilion. �2 � lrc"C �.(,°'�LtiV <br />-�-�---- <br />Does side sewer have at least 1% slope irom the builtling to sewer main? �YEs ❑ No Descnbe� <br />Have all building sevrer drain connections to ihe side sewer been idenGfied and located? �Y�s ❑ No <br />Have all property slorm drainage connections to the side sewer been identified and located? �a'es ❑ 1:0 <br />Has properly been evali�ated for drainage defciencies wilh findings communicale�l to property owner? [�j�Fes ❑ No <br />Installation Details: / <br />What type and brand ef BVJD was installed al Ihis site (Clean Check BINV, Grinder pump, etc.): -��r'�=����-- <br />Where was lhe device installed (general description, adach map)? �-C'� i �'�f�'f� • <br />Was there amf other sewer or slorm drainage work cpmpleled in conjunclion wilh the BWD work? Is so please dascribe: _ <br />Installation Checklist: <br />Are all downspouls and sile drainage disconne�ted from upstream of ihe BWD? [a':'�s—[] No Commenls: <br />Does BWD positioning meets minimum slope requirement ol >1%? es ❑ No Commenls <br />Can BWD he pulled out (or inspection and maintenance afler loosening Ihumb screw? (�a'es ❑ No <br />Is BWD loeked into the proper posilion and screw tiyhtened? �� L� No ; <br />Circle lhe BWD cover: irrig� lion co r(landscape ar aj.ld?affic load bearing cover (drive suriace) ! access hatch (building) � <br />Was property owner shown 1he location of the inst Ied BWD7 es ❑ No Comments� i <br />�---'�� Date: '7�'t'i�— 0� ! <br />Property Owner's Signature' � _ �;�� _ <br />' %,�- Z2- / S � <br />Insfaller's Signalure: �' {� Date: � <br />Revisioi�: 2 1 Fnday, September 12, 2014 � <br />