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����� BACKWATER PREVEN.TION.DEVICE F.INAL., _,. .: <br /> „ INSTALLATION CHECKLIST � ' � <br /> , �CG �C_���J; <br /> InstaliationCompanyNameandContactlnfo:AtYlfflf'«{���f14;� �`�iclr'�c'���rr L��.���� <br /> ' T` <br /> Date Dacicwaier Preventioii device{BWD).�vas installed:��Date ihis form wes compleled1� <br /> fnslallatlonPropedy0wnerNamoandConlactlnfo:�,�� ��� SI r�D,l' . �a5,'TJ��(��� � <br /> Property Address: 1��1 C'�-Q./' �• C Lp/I o lr�' ' �8�� <br /> Pro-InstollaHor InspacHon Checklict: <br /> All ilems must be checked'Yes'fn order lor a BWD to be ronsidered lorinslallefion <br /> Is thero a basemenl or level of Ihe house that is al or near assumed sewer main elevation7�Yes ❑No <br /> Flre Ihere fixtures in lho house located below the upstream sewer manhole nm elovation7�Yas ❑No <br /> Is Ihe side sewer r.urrently UNPROTECTED irom sov�er backups(does not have a BWD installed)1[�Yes ❑No <br /> S(te Inspaction Checklist: <br /> All items must be checked'Yes'helore inspection is consrd�red cromplete � <br /> Was side sewerTV inspected from buliding lo seiver main7 [�Yes ❑No CondiGon: _ <br /> Does side sewer have at least 1°,6 slape from Ihe build'mg to sewer main? �Yes ❑No Descrihe: <br /> Have all building sewerd�ain connectlons to the side sewer bean identified and lorated? (�Yes ❑No <br /> Heve all property stortn drafnage wnnectlons to the slde sewer heen Identl6ed and loCated7 �Yes ❑No <br /> Has property been evaluated for drainage deftclencins with Bndings communicalod lo property owne�l �Yes ❑No <br /> Installation Details: <br /> Whet type and brand of BWD was Installed at this sMe(Ciean Check BWV, Grinder pump,etc.):p�R_eC� `�CY`�+..�� <br /> Whe�e was Ihe devico installed(generel descripfion,attach map)7 G��' ��CCGI`�9 �-� i; I-� <br /> Was there any other sewer or storm drainage woiic compieted in canjunction wlth ihe BWD t+rork7 Is so please describe:_ <br /> �j.�'l_P <br /> Installatlon Checkllst: <br /> Arc all downspouts and site Aralnago disconnocind from upstream o(ihe BWD? �Yes ❑No Comments: _ <br /> Does BWD posilloning meets minimum slope requirement o(>t%? [�Yes ❑No CommenLs: <br /> Can BWD be pulled oul(or Inspeclion and rtiaintenance after loosening thumb screw7 [�Yes ❑No <br /> Is BWD locked into lh�per.postli n and 1'iumh screw tlghtened7 �Yes ❑No <br /> � Clmle the BWD cov r:Irri aUon cove�dscape area)I traRc load bearing cover(drive surlace)I access hatch(buiMing) <br /> Was property owner shown the IocaUon of the instelled BWD1 (�"Yos ❑No Comments: <br /> , ___,I' /�r�i'�O/ <br /> Property0wnersSignature:—���?�>`� �' Dale: $= <br /> -`" ► la !� <br /> i Inshallers SignaNre:� _ Date:_�,_Q <br /> Revision:2 1 Friday,Septembcr 12,2014 <br />