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BACKWATER PREVENTION DEVICE FINAL <br />INSTALLATION CHECKLIST <br />InstallaGon Company Name and Contact Info: �� c� ��✓��f �� - '4Z a—� 8)� ��Z�' <br />Daie Backwater Prevention device (BWD) was inst�lled.�-2-I � �ate this fortn was completed: 1-Z ! S <br />Installatian PropeRy Owner Name and Contacl IMa: <br />Property Address: <br />Predns%allation Inspection Checklis� �" <br />M items must be checked 'Yes' in order for a 8WD to be consrdered for mstaliatron � � <br />Is there a basement or level of the house fhat is at or near assumed sewer main elevation? [�}'Y�.s ❑ No <br />Are there fixtures in the house Iocated below the upstream sewer manhole rim elevation? ���es ❑ No <br />Is the side sewer currenlly UNPROTECTED from sewer backups (does not have a BWD installe�9 [�'lfes ❑ No <br />Site Inspection Checkl'�st: <br />Ali rtems must be checked 'Yes' before inspection is considered compfete n �� �� � � <br />� � �� <br />Was side sewer N inspected from building ro sewer main? [�}'�s ❑ No Condi6on: 1`"' " — <br />Does side sewer have at leasl 1% slope irom the building lo sewer main? �es ❑ No Desc�be; � <br />Hzve all building sewer drain connections to the side sewer been identified and located? �❑ No , <br />Have all property storm drainage connecbons to the side sewer besn identfied and located7 �es ❑ No i <br />Fles p�opeRy been evaluated for drain2ge deficiencies with findings communicated lo property ownefl [t.{�f'es ❑ No I <br />InsWllation Defails: ��� I <br />What rype and brand of BWD was instalied al this site (Clean Check BNN, Grinder pump, etc.): ; <br />Where was the device installed (general deuripbon, attach map)? -� �`� � 4��`LT ��� ' i <br />Was there any other sewer or slorm dreinage work c:ompleted in conjunction with lhe BWD wak7 Is so please descnbe: _ <br />I%_ / �'�.1^eC�'� � �i��—,��1"`� . <br />Installation Chccklist: <br />Are all downspouts and site drainage �isconnected frnm upstream o( ihe BWD? [�'fes ❑ No Comments: <br />Dces BWD positioning meets minimum slope requirement ol >1%? �Yes ❑ No Comments: <br />Can BWD be pulled out for inspection and maintenance after loosening lhumb sc�eu�R �`es ❑ No <br />Is BWD locked into the proper p <br />Circle the BWD cover. irtigation <br />Was property owner shown ihe <br />Property Qwner's <br />Installers Signatur�: <br />Revision: 2 <br />oi <br />tightened7 [�'f�s ❑ No <br />traffic load bearing cover (drive surface) / acoess hatch (building) <br />� ❑ No Comments: <br />Date: �l/G.h�• !i� � <br />Date: �!]- �• i � <br />Friday, Sept:�mber 12, 2014 <br />