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i <br /> � <br /> ; <br /> BACKWATER PREVENTION DEVICE FINAL � <br /> INSTALLATION CHECKLIST � <br /> Installation Company Name end Contad Into: �u m ��V� LL C �' �1� -8123 �, <br /> 3-�-r S � <br /> Date 8ackvrater Preven8on device(BWD)�ras installed: ?r-�-1 Dale this fam�s comple : <br /> r _ Q � <br /> f � ., � I n !!� q��- ��E'6(> f <br /> Installation Piopedy OwnerName and Canta�t Info:�„12�P .�,w� i <br /> Property Address:_� �i( 5� ,X�.1 CuQ� �-�T _'�V�� <br /> Pro-lnstafietion Inspectlon CAecklist <br /> All items must 6e chedred Nes'in order for e 8WD to De oonsidered for installaBon <br /> Is there a basemenl or level of the house that is at or near assumed sewer mtin elevatlon?[�'�es ❑No <br /> Are thate fl�iss in fhe house located below the upstream�wer menhde rim eleva0on7[a^�es. �No <br /> Is the side sewer arrently UNPROTECiED from sev�er badcups{does not have a BWD instalie�?[[}7� ❑No <br /> Site Inspoc�tlon Cheddist <br /> AI►;tems rmrsr ne�d'Yes�berae fnspec�ion k co►�.sidere�d c,o�r/rrafete <br /> Was side sawer N inspecled fiom budding lo sewer main? L�Kes �No Cond�ton:���<<2 G��l-1 <br /> Dces side sewer have at least 196 slope from the bu�ding to sewer mainT [���No ISesaibe: <br /> Have a4 6uilding sewer drein conne�tions to ihe side sewer been identified and located7 [�'f s �No <br /> Have a11 property slnrm drainage oonnections m tl�e sfde sewe�been identified and bcabed7 � ❑No <br /> Has piopedy been evaluated tor drainaqe dafidendes wifh fmdings canmunicated to proPetty ownefT [�'fe �P�° <br /> Instellatlon Defafls: . ��G�� <br /> What type and b�and of BWD was installed at Ihis s (Clean Ch WVh6rinder pump,elc.): <br /> Whece was 1he device installed(generai desaiptton,altadi mep)? L'� A''� �� � � <br /> Was the�e any other sewer or stortn drelnage work�n��conjundion wilh Ihe BWD worK�Is so Please descn►x:— <br /> N �- <br /> InstatlalionChecldist: ,-,,/ �y��25� . <br /> Ne ell downspouts and sRe drelnage d'�sconnaded from upsheam of Ihe BWD? L►3'res ❑No Commenis:� <br /> Dces BWD positioning meets minimum slope requi�emenl of>t%? L�es �No ,�C,a,,n�ments; <br /> Can BWD De pulled out for inspection and mainienanse afler loosening thumb screvR Ly�'es �No <br /> Is BWD lodced into the p�oper posibon a w dghtened? e�s i�� <br /> _ ... .._.._...__ _ _ . , <br /> ����gy�p�re�i�y�y� r�t�epeaeea f c load bearing cover(drive surfaee)1 aocess habch(building) <br /> Was pr�{;zrty owner shovun the bcatio es ❑No Comments: ; <br /> p�ope�ty Owne�'s Sign <br /> � v'� Date:��- �" <br /> Instaflet's Signatuie' ' - - � Uate: �L�-15J <br /> Revision:2 1 Frtday,Septembcr t2,2014 � <br />