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� BACKWATER PREVENTION DEVICE FINAL <br />INSTALLATION CHECKLIST <br />Inslallalion Company Name and Contacl'n(o: Cr9 P�urneiNc a sEavice i�c aeo•es�-s�se <br />Dale Backwater Prevenllon devi�e (BVJD) was Inste <br />Irste�ellon Property Owner Name end Conlecl Into: <br />PropeAy Addrees: <br />S Dale Ihls form �va9 <br />Pn•Imtdldlon Inapeclion CheeMltl: <br />All ilems must be checked'Yes' in order lor a BWD fo De considered forinsfelfetion <br />Is Ihere a basement cr level of lhe house that is e! ar near assumed sew�er maln elevation9 �Ye9 ❑ No <br />Are Ihere 6xlures in ihe Aouse loceted below ihe upst�cem sewer manhote rim elevalion? [�]1'es ❑ No <br />Is Ihe side eewer currently UNPROTECTED irom sewnr backups (does not heve a BWD Inetalledp �j�'es ❑ No <br />S{ta Inepeelion Checkliel: <br />All ifems must De checked'Yes' 6elore Inspectfon Is considerod complele <br />Was slde seher TV inepe�led fram building fo eewer main? [� Yes ❑ No Condition: e lu.V SC -9 S�'WL'-' <br />Does slde sewer have at least 196 slope from Ihe bullding to sewer main9 �(J Yes � No Descrlbe: <br />Have ail building sewer draln conne�tions to tAe side sewer been idenlified and localed7 [�( Yes ❑ No <br />Have all properly slorm dralnage connectlons to t�e slde eewer baen ILenlllied and located7 f�Yes ❑ No <br />Hes property been e�aluated lor drainage dnficlencies wilh 6ndings wmmunicated to property ownefl �( Yes ❑ No <br />Inttelltllon Delalli: � <br />What type and brand ol BWD was installed al this slle (Clean Check BWV, Gtinder pump�e1�c.�: I'lr« u(1/.u[/1- <br />Where wa5lhe devlco In5lalled (general descdplion, eNach mep)9 ��� �� ^•2 ��A�i� / D« So�,fl� ��t� <br />\` <br />Was there en olher eewer or atorm dralnapo work comple;ed In con�unctlon wllh Ihe BWD wo�k7 Is eo pleaae describe: _ <br />C(ecuti �/��-, <br />In�tdl�llon ChxkU�F. A <br />Are all downspou4s and sile drNinage dis�onnecled irom upstream of the BWD? (� Yns ❑ No Comments: Cnc ` <br />Doe� BWD poelllonlna mesls minimum slope requirement of >t%7 � Yos ❑ No Commenis: rs <br />Can EWD be pulled cut lor inspecllon and mainlenancc aRer Iooseninp ihumb screvA ❑ Yes ❑ No <br />le BWD lacked In10 IAo proper posltion end thumb screw tighlenad7 �Yes ❑ No <br />Clrcle It BWD caver. irt�galion cover (land3cape arca)1 traHic load bearinp cover (drive surfece) f access halch (Duilding) <br />Was properly ownar shol��n Ihe localion o! the Inetalled BWD7 ❑ Yee � No Commenls: tln�"RC WAl t`et�� <br />PropeAy Owner's Sig ur � .Q- Oale: SO V� Y��Z Y�� <br />� �— — �l�— �Z.� �S <br />Inslaller's Signature: Date: <br />Revision: 2 C 1 Friday, Septem6er 12, 2014 <br />