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f3ACKWATER PREVENTICN DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> , <br /> Instellation Company Name and Contact Into: C !\��`1 ��5 rLL'S �-��+��rS IA!( �!�( ,_ <br /> , �-i <br /> Dale Backv+aler F'revenlion device(BWQ)e;as installed: `1 3 / Date this (orm eras compleled:-��� <br /> installation Property O�a�ner Name an/d�Contaet Info: �gN�c�W� ����� <br /> Proper�y Address:�Z� '/--u C k.e� �;�- �i e, �� y ZB <br /> Pre-Installation Inspection Cliecklist: <br /> Ail ilems musf oe checked 'Yes'in order(or a BWD to be con�idered for�nstallation ,� � <br /> is ttiere a basemc:nt or level of the house ihat is at or near assumed sewer main elevation? �y'Ye ❑�o <br /> Are Ihere tixiures in the house localed belovr the upstream sevier manhole rim etevation? ^fes ❑ No <br /> Is the sitle sewer currenUy UNPROTECTED from se�^:er backups (does nol have a dN�D installed)? _ es ❑No <br /> Sitelnspection c:hecklist: <br /> Al!items must Ue r.hecked 'Yes'before inspectinn is considered complet2 <br /> �idas side sewer N insp�cted Irom building ro sev+er main? es ❑ No C ndiiinn: <br /> Does side sewer havo al leasl i%siope from the building to sewer main? Yes ❑ No De�cribe:_,. <br /> t iave all building sewer drain connect�ons to the side sewer been identified and located? [�Yes ❑�o <br /> Have all property storm drainage ccnnections to the side sewer been idenliBed and locz;.d? � Yes ❑ No <br /> Has properly been evaluated for drainage deficiencies wilh findings communicated to property o�vner7 (�'i'es ❑ No <br /> Installation Details: <br /> What type and hrand o(BWD was insialled at lhis site(Clean Check E3NN, Grinder pump, elc):C��t+t (�eCk- <br /> Where�vas ihe tlevica installed (general descriplion, altar.h map)'? .���e �a�� <br /> VJas ihere any other set+�er or s�orm drainage work cornpleted in wnjunclion wilh ihe BWD work'? Is so please describe: � <br /> Inslallation Checklist <br /> Arr.aU downspou�s and site drainage disconnected from upstream oi the BW ?' es ❑No Commr,nis <br /> Does�WD posdioning meels minimum slope rc;uiremeni of>1°0? [ es ❑ No Co inenls______ <br /> Gan f3l�VD be pulled out(or inspeclion and ma�ni.nance a(ler�oosenin�mb screw? �es ❑ No <br /> Is 47VD locked in�o the proper position and thmnb screw liyhtened? Yes ❑No <br /> Circle the BWD cover: ia�eg:�lieRfe+�landscape,�rea)1 lraific load bear ng cover(drive sudace)I access hatch(building) <br /> r , -S�wc_- �ov�;z � � <br /> Nas property otvner shov,�n I e localio�o Ihe i slallci DNID. es ❑ No CommeNs: <br /> �i- .'� . . � / <br /> Pioperly0v;ner's�Signaturc: il�•�1� � � �%�:�%.G ', Dalc: b�t o3 l Z� � � <br /> Installer's Signature:_ ���d/i� . _ • Dale:��3 ��� <br /> � <br /> Revivon 2 l Monday, September 1"s, J014 <br />