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BACM(WATER PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> fv��� �F�';rjli <br /> Instaltation Company Name and Contacl Infa P. C ,;.J`1 `�;�;c�°�-���c�P Sr..�'f.!`, �.�C.I,�:a-10-nL�1 <br /> Date Backwater Prevention device (BWD)was installed: Date this torm was completed: <br /> In�tallation ProperSy O�vner Name and Ccr.taci Info:���-f�n L(Y�O Q'��SS '_n,S. 'c����.— <br /> Property Address:��1C�C�-P. r�P L'_G�=J��, F-r:c:'L�� ��(�� — <br /> Fre-Installation Inspection Checklist: <br /> All ifems must 6e che�ked'Yes'in order for a BWD to 6e considered for installaiion <br /> is there a basement or level of the house that is at or near assumed sewer main elevalion?{�Nes ❑ �o <br /> Are there fixtures in the house localed below the upstream sewer manhole rim eievation?pYes ❑ No <br /> Is the side�ewer currently Ut�PROTECTED from sewer backups (does not have a BWD installed)?�}Yes ❑ No <br /> Site Inspection Checklist: <br /> All ifems must be checked 'Yes'before inspection is considered complete <br /> N�as side se�ver TV i:,spected from building to sewer main? (�Yes ❑No Condition:�1�� <br /> Does side sewer have a;least 1%siope from the building to sewer main? �Yes ❑ 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 sewer 6een identified and Iocated? '�Yes ❑ No <br /> Has property been evaluated for drainage deficiencies�vith Gndings communicated to property owner? ; Yes ❑ No <br /> Installation Details: <br /> What type and brand of BWD was installed at this site(Clean Check BWV, Grinder pump,etc.): "� <br /> Where was the device installed(general description, atlach map)? j L" . ��C�1 CY� �}S i�l.� <br /> Was there any other sewer or storm drainage work cpm�d in conjunction with the BWD work7 Is so please describe:_ <br /> � <br /> Installatlon Checklist: <br /> Are all downspouts and sile drainage disconnected from upstream of lhe BWD7 �1'es ❑No Commenls: <br /> Coes BWD positioning meets minimum slope requirement oi>1"/07 �J Yes ❑No Comments: <br /> Can BWD be pulled out(or inspection and mainlenance after ioosening ihumb screv+? (�(Yes ❑No <br /> Is BWD locked into the proper position and thumb scre���tightened? �Yes ❑ No <br /> Circle the BWD cover.' igation� cU(I�ndscape area)/traffic load hearing cover(drive surlace)I access hatch(building) <br /> Was property owner shown ihe location of ihe installed BWD? �Yes ❑ No Comments: � <br /> ,. , <br /> Property Owner's Signature: � /�fl� Date: /— —/� <br /> Installer's Signature: 1 � Date: � — <br /> Revision:2 1 Friday,September 12,2014 <br /> � <br />