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z, <br /> $0.77. <br /> BACKWATER PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> Installation Company Name and Contact Info: ii-74-,O i 141,7 hill 214 4 `"2,1 PI"-O(2-3 <br /> Date Backwater Prevention device(BWD)was installed: LIF/,l "Z Date this form was completed: 4 7 O 1 J <br /> Installation Property Owner Name and Contact Info: $Ay ii—t I ' (ii. 2.1'19 17(7 <br /> Property Address: 23 t Le r -v . ff- T <br /> Pre-Installation Inspection Checklist: <br /> All items must be checked'Yes'in order for a BWD to be considered for installation <br /> Is there a basement or level of the house that is at or near assumed sewer main elevation?PM ❑No <br /> Are there fixtures in the house located below the upstream sewer manhole rim elevation?[ems 0 No <br /> Is the side sewer currently UNPROTECTED from sewer backups(does not have a BWD installed)?[fps []No <br /> Site Inspection Checklist: <br /> All items must be checked'Yes'before inspection is considered complete <br /> Was side sewer TV inspected from building to sewer main? [ ❑No Condition: eitikt I/ic-f-- <br /> Does side sewer have at least 1%slope from the building to sewer main? [ems 0 No Describe: <br /> Have all building sewer drain connections to the side sewer been identified and located? [des 0 No <br /> Have all property storm drainage connections to the side sewer been identified and located? [B.-Yes- ❑No <br /> Has property been evaluated for drainage deficiencies with findings communicated to property owner? [ -'es 0 No <br /> Installation Details: <br /> What type and brand of BWD was installed at this site(Clean Check BWV,Grinder pump,etc.): aia_c_efAziit_ <br /> Where was the device installed(general descri lion,attach map)? <br /> Was there any other sewer or storm drainage work completed in conjunction with the BWD work?Is so please describe: <br /> Installation Checklist: <br /> Are all downspouts and site drainage disconnected from upstream of the BWD? Wiles El No Comments: <br /> Does BWD positioning meets minimum slope requirement of>1%? El-'r 0 No Comments: <br /> Can BWD be pulled out for inspection and maintenance after loosening thumb screw? [ems ❑No <br /> Is BWD locked into the proper position and thumb screw tightened? 11].1Fes 0 No <br /> Circle the BWD cover: irrigation cover(landscape area)/traffic load bearing cover(drive surface)/access hatch(building) <br /> Was property owner shown the location of the installed BWD? ❑No Comments: <br /> Property Owner's Signature: Date: s1-- °—1-5 <br /> Installer's Signature: -;1 Date: '';21)IS — <br /> Revision:2 1 Friday,September 12,2014 <br />