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, <br /> � <br /> BACICVNATER PREVENTION DEVICE FINAL I <br /> i <br /> INSTALLATION CHECKLIST ; <br /> i <br /> i <br /> Installalion Company Name and Contact Info:� �«� � ��-� � G'�� ��� ��Z 3 ! <br /> Date Backwater Prevenfion device(BWD)was instaGed:lo—l�'— /J� ale lhis firm was completed: �`���'`�5 ; <br /> � <br /> Inslailation Property Owner Name and Contact Info:,�YY�'� S Nn�°� J f <br /> PropertyAddress: i%���Z- ��2V�I�t�' i <br /> Pre�lnsfallation Inspeetion Checklist: i <br /> All items must 6e checked'Yes'in order for a 8 WD to 6e considered tor instalioi�on ' <br /> Is there a basemenl or tevel of ihe house that is at or near assumed sewer r�iain elevation?�'ti es ❑No F <br /> Are there fixhires in the house Iocated below ihe upstream sewer manhole rim elevation?�'f� �No � <br /> Is the side sewer curtenYiy UNPROTECTED from sewer backups(dces not have a BWD inslalted)7[�'1�es ❑No i <br /> Sitr.lnspeelion ChecklisC � <br /> All items musf be checked'Yes'6efore inspeclion is oonsidered complete � �� � � i <br /> Was side sewer TV inspecled from building to sewer main? [l]-'fes ❑No Condi6on: C?C=�%� Iv�-s^--� i <br /> Dces side sewer have at Ieasl 1°h slope from Ihe building to sewer main? [� ❑No Describe: � <br /> I <br /> Have all building sewer drain conne;,tions to the side sewer been idenlified and located? �-1`es ❑No <br /> Have all property stortn drainage cannections to Ihe side sewer been idenlified and located? [aYes ❑No j <br /> Has property been evaluated for drainage deficiencies with fin!'��gs communicated to property owner'? []'f'e`s ❑No ; <br /> Installation Details: /1 ,,,/ �� � , <br /> What type and brand o(BWD was installed at this site(Clean Check BWV,Grinder pump,etc.): ( ���-C—'"� ; <br /> Where was the device inslalled(general description,attach map)7 � 1�1ti - f <br /> �� U I <br /> Was Ihere any olher sewer or stortn drainage work completed in conjuncfion wilh the BWD work?Is so please descnbe:_ � <br /> Installation Checklist: ! <br /> Are all downspouts and site drainage diswnnected Gom upstmam of the BWD9 es ❑No Comments: i <br /> Does BWD posilioning meets minimum slope requirement ot>1%� �Xes ❑No Commenls: ; <br /> Can BWD be pulled out for inspecfion and maintenance aiter loosening thumb screw7 ��es ❑No <br /> Is BWD locked into the proper posifio twmbsr�ew 69htened7 �Yes ❑No <br /> Cir�le the BWD cover:irtigation er(landscape area�trafhc load bearing cover(drive surface)!a�cess hatch(buiiding) <br /> Was propeAy owner shown the loeation ol the inslalled BWD? �'er�No Comments: <br /> �� � bale: G� / 3_� $._ <br /> Properry OwnePs SignaWre: �Q9 _ti"� _ <br /> Installers Signalure: ^�� _ Dale: /o—� �'—(S _ <br /> i <br /> Revision:2 1 Friday,Septem6er 12,2014 <br />