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Backwater Prevention Device <br />Property Owner Rebate Form <br />Please verify the following items: <br />;�liam the owner of the property served by the side sewer where the Backwater <br />Prevention Device was instailed. <br />t�l�worked with my contractor to determine the installation location for the Backwater <br />Prevention Device. I understand that the final decision regarding installation location <br />was mine. ' <br />[� If the Back�vater Prevention �evice was instailed o,n my property: <br />• I have beer, shown how to access, inspecl, and maintain my device by my <br />contractor <br />• • I understand ihe City veiil not maintain the Backwater Prevention Dev�ce <br />am exclusively responsible to maintain it and to keep it in good working <br />order. <br />• If I sell my property, I will make the buye� aware cf the Backwater <br />Prevention Device and the need to mainlain it. <br />Choose one of the fiollowing: <br />n <br />�As of now, my property has no downspouts or other onsite drainage that connects to <br />`the side se�ver upstream of tl�e installed Backwater Prevention Device. <br />or <br />r i still have downspouts or other e,isite draii;aye that connects to the side sewer <br />upstream of the installed Backwater Prevention Device. 1 understand that leaving these <br />connections means ihal the risk of flooding from do�vnspout or onsite drainage remains. <br />I accepl that risk. <br />i5ignaturc� C��(�, , ' �' • �� 'Dlate'1 �J `� / `'� <br />... _ , i <br />Page 2 of 2 <br />Revised 09/09/2014 <br />