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BACKWATER PRfVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> Installation Company Name antl Contaci Into: A�i//o O/u/�i?�n{ [�S�3S7 �5�7 <br /> Date Bacin��aier Prevenlion device(BWD)was installed:� /o .f JDate ihis form was completed: /lo /.S` <br /> Installation Property Owner Name and Contact Info: f��.�zia s'cu.�.�.• �iG3— /�/G9 <br /> ProperfyAddress: // /� /tc.�k« 91s'� <br /> Pre•Installation Inspection Checklist: <br /> NII ifems rriust Ge checked'Yes'in order(or a BWD to 6e considered ror inslallation <br /> Is ihere a basemeni or levei ot Ihe house that is al or near assumed sewer main elevation?�Yes U�o <br /> Are there fixfures in lhe house located below the upslream selver manholc nm elevation? �j Yes ❑No <br /> Is the sitle sewer currently UNPROTECTED (rom see+er 6ackups(does nol have a BWD installed)?�Yes ❑No I <br /> Site InspecGon Checklist: <br /> NII items musf be checked'Yes'he(ore inspection is considere�d c,/omplete <br /> Was side sewer N inspected from building to se�ver main? ��Yes ❑No C ndilicn: I <br /> Does side se4ver have al leasl 1%slope irom the building to sewer main? ._ Yes ❑No Describe: � <br /> Hac�all bwlding se�ver drain connactiens to the side see�er been itlentified and located? �Yes ❑ No I <br /> Have all property storm drainage connections to the side sewer been identified and localed? u Yes ❑ N � <br /> Has property been evaluated for drainage deficiencies with findings communicated fo properiy o�vner? � Yes ❑No � <br /> Installation Details: <br /> NJhat type and brand oi BWD was installed af Ihis si ean Check BINV, rinder pump,e(c.): I <br /> VJhere eras the device installed (general descriplion, a a , <br /> ---/'�GG�G�D .✓v 1�la /�Pr�-y l�n C�r%anc;G /�ne ,iaT rn �., .w.�cL <br /> 1Nas there any other sevrer r,r slorm drainage work completed in conjunclion with ihe BN'D�vork? Is so please dexribe:__ <br /> Installalion Checklist: <br /> Are all downspouls and sife drainage diswnnected from upsiream of the BV D^ �'1�es �]No Commenis:,__ ____ <br /> �oes BWD pnsi(ioning mr.ets ininimum slope mquirement of>1°/a? �_ es ❑ No Commenls: ____ <br /> Can BVJD be pulled out for inspection and maintenanoe alter loosenin,y ti��mb screw? ��es ❑No <br /> Is BIND lockr.d inlo Ihe proper posilion and ihumb screw tightened? _ Yes ❑ No � <br /> Circle lhe BVJD cover:irrig ion cover(landscape area�ra(Gc load bearing cover(drive siuface)1 access halr.h(building) <br /> N'as property owner shown the lo�alion o t ie inslalled BWD? _ Yes ❑ No Comments: <br /> i <br /> Properfy Owncr's 5ignalure: s�1� �/YjN ��ie:_�_�g�/_-�L3 . <br /> Inslallers Signaf _ Dale: �� /,� ____ <br /> I <br /> Revision: 2 t Monday,Septr.mber 15,2014 I <br />