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�� <br />� <br />BACKWATER PREVENTION DEVICE FINAL <br />INSTALLATI9N CHECKLIST <br />/,� Joe- Zl� b <br />�iii/� Z �DMT/dc�d/S/ ��iG <br />Installatioa Company Name and Coniact Info: ,¢�¢rvut ,l�1Dr��a.ca 3C�J�3Y/'8'75/ 'fZs-gi b�%305 <br />�khiu <br />Date Baclnvater P�evention device (BWD) was installed: �� -�zaiS Da�e this form was ccmpleted: ��" G- /� <br />Installation Prooerty Ov�ner Name and Con!act Info: �')ar�K0. ZIn b i.Z.� -y71- 6717 <br />Property Address: � G 17 �v14� �P��i/,7 Je. �, � ei t fY. W F}- �j �, Zul _ <br />Pre•Installation Inspection Checkiist: <br />All ilems must be checked 'Yss' in oider for a B WD to be considered (or insfallation <br />Is there a b�sement or level ot the house that is at or near assume� se�ver main elevation? �j Yes ❑ No <br />Are lhere fxtures in thA house located below the uostream sewer manhole rim elevation?� Yes ❑ No <br />is ihe side sewer currently UNPROTECTED from se�ver 6ackups (does not have a 8WD installed)? 0 Yes ❑ No <br />Site Inspection Checklist: <br />All items must be checked 'Yes' before inspection is considered complete <br />Nlas side sewer N inspected (rom building ro sewer main7 � Yes ❑ No Condition: ��- <br />Does side sewer have at least 1% slope irom the building to sev�er main? � Yes ❑ No Describe: Z`/n _ <br />Have all buildino se�ver drain connections to the side sewer been identified and located? � Yes ❑ No <br />Have all property storm drainage connections to tha side sewer been iden,ified and located? X� Yes ❑ No <br />Has property been evaluated for drainage deficiencies with findings communicated to property ov�neR Q Yes ❑ No <br />Installation Details: <br />What type and hrand of BWD was installed al this sile Clean Chec. B�NV, Grinder pump, etc.): G �PL� C�rPclr 4� <br />Where was the device installed (general description, aqach map)? /1'1�'� y�Iul'l,���, r r�� � Srpc�'4� l.'nrs ��+ .��n•�� <br />n�_ �orlc, n�.,�! l�n ��1�� aa;0. O�e s�,dG� Gv,c� S2� �/n a���P• -- — <br />4Uas there any other see�er or storm drainage work completed in conjunclion �vith the BWD �vork? Is so please describe: _ <br />Installation Checklist: <br />Are all downspouls and site drainage disconnected (rom upstream of the B1�VD? � Yes ❑ No Comments. <br />Does BWD posilioning meels minimum slope requirement of >1°0? � Yes ❑ No Comments: <br />Can BWD be pulled out for inspectior, and maintenance afler loosening tfwmb screw? jgf Yes ❑ No <br />Is BV�•D lacked inlo ihe proper position and thumb screw tightened? � Yes ❑ No <br />Circle the BWD cove( irrigalion cover (landscape area) traffic load bearing cover (drive surface) ! access hatch (building} <br />Ul�as properly owner shown lhe location of lhe inst�lled BWD? [�Yes ❑ No Commenls: <br />Property Owner's Signature�<��I�L�i�!///� Date:// -6'/S <br />Installer's Signature: �`r.Wf � Date:. 1�- 6-�S <br />Revision <br />Friday, September 12, 2014 <br />