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� <br />BACKWATER PREVENTION DEVICE FINAL <br />INSTALLATION CHECKLIST <br />installalion Company Name and Conlacl In(o: <br />Date backwa�er device (BWD) was installed ' <br />Installation Property Owner Name and Contac <br />Property Address: �2� � <br />� <br />Info: <br />Date ihis form vras completed:� — 7—% s <br />Pre•Installation Inspection Checklist: <br />All ifems must be checked'Yes' in orde� for a BWD to 6e conside�ed /or installation <br />Is ihere a basement or level o( lhe house lhat is at or near assumed seever main elevalion?�Yes ❑ No <br />Are there fixtures in tha house located below the upslream sewer manhole rim elevation7 �J'Yes ❑ No <br />Is ihe side sewer currenlly UNPROTECTED from se�ver backups (does not have a BWO installed)?� Yes ❑ No <br />Site Inspection Checklist: ' <br />All items must be checked'Yes' belore inspection is considered.complete <br />tNas side sewer N inspected from building to sewer main? �Yes ❑ No Condition: <br />Does side see�er liave at least 1%slope from the buiiding to sewer main? �Yes � No Describe� <br />Have all building sewer drain connections to the side sewer been ideNified and located? (�Yes ❑ No <br />Have all property storm drainage connections to the side sewer been identified and located? ��Yes .❑ No <br />Has praperty been evaluated for drainage deficisncies �vith findings communicated to property owner? �Yes ❑ No <br />Installation Details: i�� � �� <br />Whal type and hrand o( BWD was installed at lhis site (Clean Check BWV, Gfinder pump, elc.): <br />Where �vas the devic insialled (general description, altach map)? �e � <br />�� ��� <br />Was Ihere any other sewer or storm drairc,4e�work compleled in conjunclion �vith the ABWp work? Is so please describe: <br />Installation Checklist: <br />Are all downspouts and site drainage disconnected (rom upstream of the BWD? �Yes ❑ No Comments: <br />Does BWV positioning meet minimum slope requiremenl of >1%� �Yes ❑ No Comments: <br />Can BVIN be pulled out (or inspeclion and maintenance after loosening thumb screw? �Yes ❑ No <br />Is BWV locked into the proper posilion and thumb screw tightened? �Yes ❑ No <br />Circle the E31NV cover. irrigalion cover (landscape area)7lraffic load earing cover (drive surface)/ access hatch (building) <br />Was homeo�vner shovan the location o( the installed ABWD7� Yes ❑ No Comments: <br />Property Owner's Signatur : __ Date: <br />installer's Signature: - Date: 'T %'—/�' <br />� <br />Hevision: 2 1 Thursday, October 02, 2014 <br />