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I <br /> r • � <br /> i <br /> BACKWATER PREVENTION DEVICE FINAL <br /> E� r INSTALLATION �CHECKLIST <br /> � <br /> i <br /> i /1 n <br /> Installation'.Company Name and Contact In(o: l ,A���� PJ'y�i.L�� 1"L-V+1�fS I �(��( . <br /> Date Dack�i aler Prevention device (BNrD)vas installed: 2 /, Dale this torm was wmpleted: �' 3d <br /> Inslallation�PropeRy Owner Name and Contact Info:.����� �;1sa,1 <br /> Property Address' 1 5/s �a�.lu�--��, �c,,�� _ ,lJ ' � � ! <br /> Pre•Installation Inspection Checklist: � <br /> i <br /> Aff items musl be checked'Ves'in order(or a BWD to be considered lor installalion <br /> Is there a basem�N or level of lhe house ihat is at or near assumed sev;er main elevation? Y s ❑ Nc <br /> Are ihere fixfures in Ihe house localed below the upslream sewer manhole rim elevation? Yes ❑No <br /> Is the side seerer currenUy UNPROTECTED Irom sewer backups(does not have a �l�'D installed)7 Yes ❑ No <br /> Site Inspec,tion Checkiist: i <br /> All items musf be checked'Yes'belore inspection is considered co le'te <br /> l,l�as side se�ver N inspected from huilding to setiver main? Yes b No Condition: <br /> Does side sewer have at leasl t%slope from the building to sewer mai�? Yes ❑No Describe: <br /> Have all building sewer drain connections lo the side sem�er been identifed and located? 'es Plo <br /> Have all propeity slorm drainage conneclions to Ihe side sevaer been idgntified and located? Yes ❑ No <br /> Has proped} been evaluated for drainage deficiencies with findings communicated to property o�vner? �s ❑ No <br /> Installatirn Details: <br /> UVhat type and brand oi BWD was installed at this site(Clea�Che:k BNN,Grinder pump, etc.): C����„ �'�� (L <br /> i <br /> �r�rhere was the device inslalled(genIe�ral descnption, a�ta�h map)? � �c fG, cu�— .r �.!___��_.E.r.�,� S <br /> ._�QiOr•��� . ow�� -� oast%�'t.c�� i <br /> �r�r�5 ihr.re any oHier sen�er or slurin drainage �vork completed in conjunction with the DWD work?Is so please describe:�Q <br /> Installation Checklisk I ' <br /> Are all dormspouls and site drainage diswnnecled irom upstream nf tha p D? Yes ❑ No Commenis:__ <br /> Docs BWD posilioning meets minimum slnpe iequiremenl of>1%? IYes [� No Co ments: <br /> Can E3N�D be pulled ouf for inspeclion and mainlenan�e aller loosening (humb scre�v7 �Yes ❑ No <br /> Is BbVD locked into Ihe proper position and thumb saetv tighiened? �Y�s ❑No <br /> Circle Ihe BWD cover: irrigation cover(landscape area)I fra(fic load eaiing co��er(drive surtace)I access hatch(building) <br /> lNas property oemer shown lhe location oi ihe insfalled B�A�D? [�Yes i� No Commenls: <br /> ProperyOe�nersSignature:��� _ I fDafe: ' 3 : 3p ,�p�5— <br /> Inslaller's 5ignalure:' /"///u�,� � '� 3� ' <br /> __ Dale:—J_�/� <br /> � � — <br /> fievision 2 1 i Monday, September 15, 2074 <br />