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� <br />� <br />BACKWATER PREVEN �HECKLIST F�NAL <br />INSTALLATIO <br />---- �,rc <br />u,� �Lu�M i h ' <br />Installalion Company Name and Contact Into: R'"`� pate lhis form was completed:.��L�-- <br />Dale Backwater Prevenlion devir.e (B1ND) was installed: I I � V�1 v� yZS S� � <br />Installation rrcperty Owner Name and Contact Info: M`'�' n.� '_ d ak2D <br />Properlyl,�wass: �2 a -"' .-. <br />Pre•Installation Inspection Checklist: <br />All items must be r,necked 'Yes' in order (or a BWD to be considered for installation <br />Is Ihere a basemE:nt or level of the house thWtt�seaU°str�eam se rer m nhele nm e evaGon? ��5� No0 <br />Are there fixtures in ;he house located belo P <br />Is the side sewer currently UNPROTECTED fruni sewer backups (does nol have a BWD installed)? es ❑ No <br />Site Inspection Checklist: <br />All i(ems must be checked'Yes' before inspection is considere��slete❑ No Condition: ���— <br />Was side sewer N inspected from building to sewer main . e5 No Describe: � <br />Does side sewer have at least 1% slope irom the building to sewer main? � � �,,� � No <br />Have all building sewer drain conn on,nect ons lo the side sewee beennidenilfied and localed� `lJ T cs ❑ No <br />Have a l l p r o p e r t y s t o r m d r a i n a g e c o w n e r? �es ❑ No <br />Has property been evaluated tor drainage deficiencies wilh findings communica te d t o p r o p e r ty <br />Installation Details: ' elc. �� F� C�K P'-`�✓ <br />Whal tyPe and brand of BWD was installed at this site (Clean Check BWV, Grinde�p�P. ��� �� hF _ <br />Where was the device installed (general descript;on, attach map). <br />� � ��EL ►�rT BW�% di� ►n3[fEae6 i�-�CAf�• <br />Was there any other sewer or stPorm d�rafn�ag�v+o� f� P�� d in conjunction with the BWD work? Is so please describe: _, <br />Installation Checklist: � ,,-,� No Commenls: <br />Are all downspouts and site drainage disconnecled irom upstre am�of �th._e,, �BWD • U' eSC � enls: _�-- <br />Does BWD positioning meels mii�imum slope requirement of >1 /a • LI Yes � ❑ <br />Can BWD be pu l le d out for inspection and maintenance after loosening thumb screw? �eS No <br />Is BWD locked into the proper position and thumb screw tightened? �es ❑ No <br />Circ le t h e BWD cover: irrigalion co� t on ot he nstal ed BtWD? load be5��� a N o r( Commenis )� access iiatch (buildingj <br />Was property owner sho�vn ihe loca . <br />� Date: �� -�� �� <br />� ' �1�w�1�/ <br />property Owner's Signature: Date: <br />I Instalier's Signature: <br />1 <br />Revision: 2 <br />Monday, September 15, 2014 <br />