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BACKWATER PREVENTION DEVICE FINAL <br />INSTALLATION CHECKLIST <br />Installation Company Name and Contact Info rc f22 <br />Date Backwater Prevention device (BWD) was installed: 2 z. c Date this form was completed;_z iL <br />Installation Property Owner Name and Contact Info: <br />Property Address. <br />Pro -installation Inspection Checklist: <br />All items must be checked 'Yes' in order for a B141D to he considered for installation <br />Is there a basement or level of the house that is at or near assumed sewer main elevation?9�1_yes ❑ No <br />Are there fixtures in the house located below the epstream sewer manhole rim elevation? Yes ❑ No <br />Is the side sewer currently UNPROTECTED from =^.wer backups (does not have a BWD installed)? KLYes ❑ No <br />Site Inspection Checklist: <br />All items musf.be checked 'Yes' before inspection Is considered complete <br />.Was side sewer TV inspected from building to sewer main? FlYes ❑ No Condition. <br />Does side sewer have at IeFst 10% slope from the building to sewer main? FLYes ❑ No Describe: <br />Have all building sewer drain connections to the.side sewer been identified and located? ,Yes ❑ No <br />Have all property storm drainage connections to the side s^war been identified and located? ®Yes[I No <br />Has property been evaluated for drainage deficiencies with findings communicated to property owner? Dn Yes [] No <br />^Installation' Details: <br />What type and brand of BWD was installed at this site (Clean Check BWV, Grinder pump, etc.): �' (t r n F �n C c k <br />Where was the device installed (general description, attach map)? SLAP <br />a- <br />1 <br />Was there any other se`2ver or slonn drainage work completed in conjunction with the BWD work? Is so please describe: — <br />�e C— C7k c+ w e — l_✓ , e O C e O� o �Ltni{1 tll{�+8 <br />Installation Checklist: `t—yC Z t v S f/ 5 <br />Are all downspouts and site drainage disconnected from upstream of the BWD7 e-Yes ❑ No Comments'. <br />Doer BWD positioning meets minimum slope requirement of >1%? aYes ❑ No Comments: <br />Can BWD be pulled out for inspection enr! maintenance after loosening thumb screw? ayes ❑ No <br />is BWD locked into the proper position and thumb screw tightened? JaYes ❑ No f <br />GlfGie (he dl(VD cover. litigation cover (landscape area) I traffic load bearing cover (drive surface amass a � lalrlg) <br />Was property owner shown the location of the Installed gWD? gYis ❑ No Comments: <br />Property Owner's Signature: '' Date: <br />Installer's Signature: Date: d2 2 Lf I Tyi <br />Revision: 2 1 Friday, September 12, 2014 <br />