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. � �-13� <br /> ' � BACKWATER PREVENTION DEVICE FINAL <br /> � INS`fALLATION CHECKLIST <br /> � - <br /> Installalion Comp�ny Name and Contact Info: �,�ru� (�('��LL�S t"L. n1��S in�(� f A; ( <br /> 7� <br /> 'Date Ba�k�valer Prevention tlevice.(8WD)was inslalled: 7I1� I5 ,Dafe ih'is:for ves.comp e etl � /5 <br /> Inslailal�roper,t,y,,�Ow,_ne..�rNa,,m�eand'C� ontact'Info'�_�'qndace , �4,rsar� <br /> �ropert�y dress:7 �?Z�IA-��k e✓ 14U2.. �oc.(ti+ vJ f4 q$'Z�� <br /> Prc•Installation Inspection Checklist: <br /> AA ifenis must be checked 'Yes'in order fa a BWD fo 6e considere�lor ins�aNation <br /> Is there a basement or level of the house Ihat is at or near assumed sewer main elevation?[] Yes ❑ No <br /> Are ihere iixtures in ihe house located below the upstream sewer manhole rim elevation? es ❑No <br /> Is the side seiver curreNly UNPROTECTEO from sewer backups (does not have a f3WD installed)? Yes ❑No <br /> Site Inspeclion Checklist: <br /> Hll items must be checked'Ves'be(o�e inspection is considered complete <br /> UJas sitle sewer N inspected irom building to sewer main? [�es ❑ No Co tion: <br /> Does side setver '�ave at least 19a slope from ihe building lo se�ver main? _ Yes ❑ No D scribe� <br /> Have all huiiding sewer drain conneclions to lhe side sewer been identified and localed? [�Yes IJo <br /> Flave all properiy s�or,m drainage connections to Ihe side se��aer heen idr,nlilied and lor,aled? Yes ❑ No <br /> Has properly been evaluatr.d(or drainage deficiencies wilh findinys communicaletl (o property owner? �s ❑No <br /> � <br /> Installafion Detaiis: <br /> VJhat lype an�i brand;of f3WD was installed at Ihis sit .(Gcan Check B Grinder pimip, elc.): ____ <br /> �lJhere was(he device inslalled (general descriplion, a eN-rtrep , f��U�j{-1 Uf i�S I �D(z(U �� <br /> --�-`---- <br /> D;��-��S�- <br /> ,!Nas iheir. an�othcr sca+cr ar slorm drainage work camplcled in conjunGion wilh Ihe BWD�aork7 Is so please desr.ribe t��Q <br /> i� ` •l � <br /> `- - -- - - - ' — ---- <br /> . , --- -- — <br /> Installation Checkli�L• <br /> Are all dov;nsprnit,and sile dramaye disconnecled from upslream ol tlie � D? [_ Yes � ] No Comments:_____ _ <br /> Uocs f�VdD posifioni�ig meeis minimurn slope requirement o(>i"/�? Yes ❑ No �ments:_ __ <br /> Can HWD be pullr,cl out(or inspection and maintenance a(ler loosening�hu •screvJ? � Yr,s ❑No <br /> L;13VJp locked into Ihr,proper position and ihumh screve tiyhlened? �_�Yos ❑ No <br /> CiiGr, Ihe BWD c�wer:i�+q;;�i�n�Lr andscape area)/Uaffc load bearing cover(drive suriace)1 acr,ess halch (building) <br /> 'JJas prupeity,owner sh�wn helocalio�Ihe inslalled BWD? e, [ ) No Commr,n�s: <br /> . I� ----- <br /> 'f:iop"�ciiy�O�NnerS Sigfiatu e---�-�(,�gL9-Cc� .� �cq�L Date�� ' 9l1 �S <br /> -- -7 r�---- . <br /> Installr.r's 5ignatuie:���� � _ _ _ Date:__� /�� <br /> Revi;ion: 1 , ] • Mond,�y, Sepiemhrr 1S, 01A -- <br />