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BACKWATER PREVENTION DEVICE FINAL � <br /> INSTALl�ATION CHECKLIST <br /> Installation Company�ame and Contact Info: 1'i$`ra ������I M� <br /> Dal�Bacint�ater Prevenlion device(BWD)was installed:_ Date this torm v�as completed: , <br /> Installation Prooerty Owner Name and Contact Infa '�Yv✓ �vw�cyv� yZS—�N I—7,7,'�� ; <br /> Property Address: _1 I11 t��c_(}�i c A,,vL E1,'F'itti'T� . V'�ic� ��7 U� � <br /> Prrinstallation Inspection Checklist: � <br /> Ad ifems must be checked 'Yes'in order for a BWD to be cronsidered(or instaifation � <br /> Is ihere a basemenl or level of the house that is at or near assumed sewer main elevafion? Yes ❑ No <br /> Are there fixtures in the house located below the upsUeam sewer manhole rim elevaGon?�es ❑N <br /> Is the side sewer currently UNPROTECTED from sewer backups(does not have a BVJD installed)? �s ❑ No � <br /> Site Inspection Checkiist: <br /> Afl items must 6e checMed'Yes'before inspection is considered com ete � <br /> 1Nas side sewer TV inspected from building to se���er main? es ❑ No C udifion: <br /> Does side sewer hzve at least 1°i� slope from the buifding to se�ver main? � Yes ❑ A'o Describe: <br /> Have ali building sewer drain connections to the side sewer been idenfified and loeated? �s ❑No <br /> Have all property storm drainage connections to the sitle sewer been idenlified and locatetl? �1'es ❑ No <br /> Has propeiy been evaluated for drainage de5ciencies H�iih findiogs communicate� to property ovmer9 �es ❑ No <br /> Installation Details: ,/ <br /> VJnat q�pe and brand oi BWD was instal{ed at th��site(Clean C ck BVJV, Gnnder pump,etc.):C�-��� efT efC�C <br /> 1Mhere was the device installed (general desuipti ,aflach map)7 � <br /> VJas Uiere any other se��;er or storm drainage H�ork completed in conjunction vrith Ihe BWDwork? Is so please descnbe:_ � <br /> Installation Checklist: ! <br /> Are all downspouts and site drainaae disconneded from upslream nf the BWD? Yes ❑No Comments: I <br /> Does BWD posiboning meels minimum slope requirement o(>1%? �es ❑No Comments: <br /> Can BWD be pulled out for inspection and maintenance aRer loosening fhumb screw? �s ❑ No <br /> Is B4ND locked inlo the praper position and thumb screv�fightened? �es ❑No <br /> Circle the BIND cover.irrigation cover{landscape area)!traffc load ring cover(drive s��ace)1 access hatch(building) <br /> N'as property owner shown the location of the installed BN'D7 Ycs ❑ No Comments� <br /> Propery Owner's Signature:�l��.w-- Date: � � a <br /> Installer's Signature: �� Date: � � �� <br /> 1- i <br /> Revision: 2 1 Tuesday,September 16,2014 � <br /> � <br />