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BACKWATER PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> Installation Company Name and Contact info: P'�De,•� �l�„r�,l���'4 �/2 S -7�0-k-3(_.c; <br /> Date Backwater Prevention device(BWD)was installed: f�-`/- ��{ Date this form was completed: �d-`�-1 y <br /> Installalion Property Ov�ner Name and Contact Infa_ M Cyc�v G-r�o�u� I � `�2 S� �3 �-3� 7� <br /> �,7�� <br /> Property Address: �l��( v4��S l� r..cr'c-f-f wA <br /> Pre-Installation Inspection Checklist: <br /> All items must 6e checked'Yes'ir�oraei for a BIND to be considered for installation <br /> Is there a basement or level of Ihe house lhat is at or near assumed sewer main elevation?�Yes ❑No <br /> Are there fixtures in lhe house located below the upstream sewer manhole rim elevation?�Yes ❑ No <br /> Is ihe side sewer currenqy UNPROTECTED from sewer backups(does not have a BWD installed)? k❑Yes ❑No <br /> Site Inepection Checklisk <br /> All i(ems must be checked'Yes'before inspection is cansidered campiete <br /> Vt�as side se�ver TV inspzcted from building to sevrer main? �Yes ❑No Condition: <br /> Does side sev;er have at least 1%slope from the building to sewer main? �Yes ❑No Describe: <br /> Have all buiiding sewer drain conneclions to the side sewer been identified and located? 0 Yes ❑ No <br /> Have all property storm drainage conneclions to;ne side sewe;been identified and located? Qk Yes ❑No <br /> Has property been evaluated(or drainage defici.ncies wilh findings communicaled to property owner? ['Yes ❑ No <br /> Installation Details: <br /> lNhat type andhrand of BWD was insfalled at this site�Clean Cher.k BWV, Grinder pump,etc.): L�-n/11.,� <br /> Where was the devir.e installed(general descripiion,attar.h map)? Un I-1oor .ln,•� T„� yUr_ <br /> r_.�9fn�� <br /> Was there any other se�ver or storm drainage work complefetl in conjunr.tion with fhe BWD work? Is so please describe:_ <br /> N�� <br /> ----, <br /> Installation Checklist: <br /> Are all downspouls and site drainage disconnected from upslream of the BVJD'? �Yes ❑ No Cnmments: <br /> Does BWD posilioning meets minimum slope requirement of>1%? �Yes ❑No Cnmments: <br /> Can BWD be pulled out(or inspection and maintenance after loosening thumb screw? [�Yes ❑ No <br /> Is BWD locked into ihe proper position and Ihumb screw tightened? �]Yes ❑ No <br /> Cirr.ie the BWD cover: irrigation cover(landscape area)/fraKc load bearing cover(drive surface)1 access hatcli(buildir�g) <br /> Was property owner shovan lhe location of lhe inslalled BWD? [j Yes ❑ No Commenls: <br /> Property Owner's SignaWre: Date: <br /> Installers Signature: �� � :�°�-�-- Dafe: I 2��l- �`�l <br /> Revision:J 1 Monday,September 15,2014 <br />