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BACKWATER PREVENTICIN DEVICE FINAL <br />E„ INSTALLATION CHEC�:LIST <br />?erFMJ/7a;y�.; 3Lo— 3�+/-g7s1 <br />Installation Company Name and Contact Info: SMZ C�nirQ�ic�s cc.c <br />S�e z146 �r2s•�7�- 73�s <br />Date BackwalPr Preveniion device (BNiD) �+�as installed:l1'y?l,rw ��'S"�SDate this form v;as completed: i 1- 6-1 S <br />Installalio� Property Ovmer Name and Contact Info: � N 4W ���'t�( 4 6��1 Z S- `� 7�'E��7 <br />Propertyl�tldress: �6�I /1v�kc,�'��r��L F��.rFfl WA `)b'2v� <br />Pre•Installation Inspection Checklist: <br />A�I itams must be checked 'Yes' in order (or a BWD to be considered /or irslailatron <br />Is there a basement or fevel of lhe ho,�se that is at or near assumed sev�er main elevation? �j Yes ❑ No <br />Are there fixlures in the housa located below the upstream sewer manhole rim elevation7 � Yes ❑ No <br />Is the side see+er currently UNPROTECTEO from se�ver backups (does nol have a 84VD installed)? � Yes ❑ No <br />Site Inspection Chr,cklist: <br />Afl items must be checked'Yes' bef�re inspection is considered compfete <br />1Nas side sev�er TV inspected `rom building to se�ver main7 � Yes ❑ No Condition: 8 k <br />Does side sewer have at lea=t i°o siope irom the building to setiver main? � Yes ❑ Nu Describe: 2- � <br />Nave ail building sewer drain cor,�ecfions to the side sevrer been identified and locatPd? � Yes ❑ No <br />Have all property sform drainage connecticns to lhe side sewer been ideneified and located7 (X� Yes ❑ No <br />Has property been evaluated tor drainage deficiencies a�ith (indings communicated to property ovmer? [� Yes ❑ No <br />Installation Details: <br />INhat type and brand ot BWD v+as �nstalled at this sii Clean Ch k VJV, Grinder pum�, etc.): CI «� ���eck `� � <br />VUhere a�as the tlevice insialled (general description, attach map)? �?QP ��4C1�E3 . I ���� N�r: '' •` - <br />37' �o �PiJc'f'Mn�'rt Dr�f' <br />Was there any olher se�ver or slorm drainage ���ork compteted in conjuncticn �vith the BWD v�ork? Is so please descri6e: _ <br />�N c7 <br />Installation ChecNlisL <br />Are all do�vnspouts ard sile drainage disconnected trom upsiream of the BWD? � Yes ❑ No Commenis: <br />Does B'n'D positioning meets minimum slope requirement of >1%? (� Yes ❑ No Comments: <br />Can BWD be pulled out for inspeclion and mainienance after loosening thumb screw? � Yes ❑ No <br />Is 84VD locketl into the proper �osilion and thumb screw tightened? � Yes ❑ No <br />Cirde the BWD cove rri alion cover (landscape area 1 traffic load bearing cover (drive surface)1 access hatch (building) <br />Was properiy o�vner sho�vn the locaiion o( the instal!ed BWD? �C] Yes ❑ No Commenis: <br />Proper�y Ovmer's Signature: � �ate: // -6 '/5 _ <br />Installer's Signature: ��. Date: II - E-iS <br />/ <br />Revision: 2 I Friday, September 12, 2014 <br />