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- � <br /> i <br /> �AC�(WATER �REVENTION DEVICE FENAL I <br /> iiVSTALLATiOiV CFIECKLIST ' <br /> i <br /> � <br /> i'►"�t'(`i C:cc1"1 `'.�'r �G ^!� a"�d� ��.L'�' L LG � <br /> � <br /> Installation Company Name and Contact Inio:..1s CC ���Y•l ' �s)y�-�.�:5.���'.;��n� LL�"�,]'��)� .�?�� i <br /> Date Backwater Prevenlion device(BWD)was installed: �i 5 Dale this form was completed: 3 � . � � <br /> Inslallation Property Owner Name and Conlacl Info:�y) '�=,� .�. �r}�'ti IA cC�5�61 �{���; — �J I - I.S��� � <br /> PropertyAddress: 17r�,� ��tC'..� n' �� '� r;r i:i��� ��'�S�]c'>� <br /> Pre-Instaliation Inspection Checklist: <br /> A!!ifems must be checked'Yes'in order lor a Al4�D fo 6e considered for insfallation , <br /> Is ihere a basement or level of the house ihat is at or near pssumed sewer main elevation7�Yes ❑No <br /> Are there fixlures in Ihe house located below the upsiream sewer manhole rim elevation? �Yes ❑ No <br /> Is fhe side sewor currently UNPROTEC�ED from sewer backups (does not have a BWD installed)1(�Yes ❑�Vo � <br /> Sfte Inspection Checklist: � <br /> Aff ifems must be checked'Ves'belore inspection is considered complefe <br /> Was side sewer N inspected trom building to sewer main? �Yes ❑No Condilion:_�,�� <br /> Goes side sewer have al leasll%slopa from the huilding to sewer main? �Yes ❑ No Descnbe: _ � <br /> Have all building sower dr�in connections to Iho side se�ver 6een identified and localedl (�Yes ❑ No <br /> Havo all property storm drainage conneetions to Ihe side sower been idenlified and la;ated? �Yes ❑ No ; <br /> Has property been avaluated for drainage deficiencies with fintlings communicaled lo properly owner? �Yes ❑No ; <br /> Installation Details: I <br /> What type and brand of BWD was instailed at this site(Clean Check DWV, Grindor pump,etc.):_ ' '=;r� �_.1�. � j <br /> VJhere was Ihe device inslalled(yeneral descnption,attach map)? ��(' (Z���;�t�L( _.,�5_�(,{�-� <br /> _,— i <br /> VJas�here any olher sewer or storm drainage work ampleled in conjunr.lion wilh Ihe BWD work7 Is so piease describe:_ ' <br /> -- -- -- — —�--� (1)�l(!_ ; <br /> InstallaHon Checklist: <br /> Are all downspouts and site tlrainage disconnecled Gom upslream of Ihe f3WD7 �Yr,s ❑No Commenls: � <br /> Daes BVVD posilioning meels minimum slope requirernent of>1%? �Ycs ❑ No Commenis:__ i <br /> � <br /> Can 8WD he pulled out(or inspeclion and mainlenanr,e a(ter loosr,ning ihumb screw7 �}' es ❑No i <br /> Is BWD locked into the praper posilion and ihumb scree�lightened? ��Ycs ❑No . <br /> Circle(he BWD cove . irrigalion cover( scape area)!lra(flc load bearing cnver(drive sudace)I ar,cess hatch(Iwilding) ; <br /> �--- i" � <br /> Was property ovmer shown Ihe l0y3tion gl�the inst U WD'? ��Yes ❑ No Commenls: ; <br /> {/ +� � , �_� <br /> %�Properly Owner's Signalura fl �� d Date; � � � <br /> --p � : <br /> Installer's Siynalure:___ � �' �f.�� Date:__.,_����J ; <br /> —•� i <br /> � <br /> Ncvisinn: J � 1 1-riday,Seplcrnbcr]2,2014 <br />