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- BACKWATER PREVENTION DEVICE FINAL � <br /> INSTALLATION CHECKLIST <br /> Inslallation Company Name and Conlacl Info:��'� ����LL�S 1"L �1rl�TS li\�(a�,(�%( . <br /> Q��le Backwaler Preve�tion device (BWD)v;as installetl:�`1�1 S Date lhis torm was coinpleted: �'3 S ( '� <br /> Installation Properry Owner Name and Contact Info: i a QS <br /> P�OpC�ty Addf255:���.��_�'�!��l���Y•� I n.�a q�7 03 <br /> Pre-Installation Inspection Checklist: <br /> All ifems must be checked'Yes'in order lor a BWD to be considered(or rnsfallafion <br /> Is therr,a bosement or level of the house ihat is at or near assumed seerer main elevation?[ es ❑ No r <br /> rlre I�iere(xtures in lhe house located bclo�•�ihe upstream sewer manhole rim ele��ation? Yes ❑ No � <br /> Is Ihe side sewer currently UIJPROTECTED(rom sewer backups(does not have a BWD installed)?�es ❑ No <br /> � Site Inspection Checkiist: <br /> lill Aems must be ciiecked'Yes'before inspection is considered con pfete <br /> �Nas side seaer 1V inspecietl from building lo sewer main? � es ❑ No Condition: <br /> Dor.s sidr, sewer have al least 1% slope irom the building lo setver main? v�Yes ❑N,o�,/Dc;scribe� . <br /> liave ail huildiny sev+r.r drain connections lo ihe side se�,�er been ideniified and located? L'7 Yes ] No � <br /> N;3ve all property stom�drainaae conneclions to ihe side sewer been identified and Incaied? �Yes ❑��No <br /> lias property heen evalualed for dreinage deficiencies with tindings cummunicated lo property o�vner? ��(Yes ❑ IJo i <br /> i <br /> Installation Qetails: � <br /> 10'hat type antl hrand oi RW�was installed at this site(Clean Cherk BNN,Grinder pump, elc.):�r Cl+�k __ ; <br /> V��here v.�as ihe de��ice installed (general desr.ription, F1tl�Ch 1118�)�? _c d�r�L /7�o�P. v� �-o as'/e <br /> -�-tY-ro1�__�-n`� c O�Q`D r_.F1.oy3Q'�b ON.�" J -K411 -{-�o M -�b.n,..o�0.�/-� e w� _.__' <br /> Vdas there any other sswer or slorm drainage work compleled in conjunction vailh Ihe f3��'1D work? is so please describe:�o <br /> installation Checklist: _� <br /> Are all dovrnspnuts and site drainage disconnected from upsiream of 1h�0? �°J"Yes � � No Commenis:.____,_ <br /> Cocs 64VD posilioriny mcels minimum slope reyuirement of>14'�7 �_ es ❑No -C�,o/mmenls. ______ <br /> Can f341+D t�e pulled oul for insper,linn and mainlenance aller loosening ihumb sr.rew7 �7 Yes []No <br /> Is HWD locked inlo lhe proper posilinn and lhumb screw tightened? (�es [_� No <br /> Circle lhe BWD cover ' ' ' pe area ra ic oad e�ring cover nve sur a� .�`'iatch(buildin9) <br /> SEw�4 l <br /> N'as property owner shoti��n the locati n'o;� nslalled�N1D% ��Yes [] No Comments: __ ______.__ <br /> ; ' i <br /> Property Ov;ner's SignaWre: .� Date: 3 � <br /> Inslaller's f.ynature: ✓ � � � _ ___ Da(e: 3 /y115 <br /> Revision:2 `��, i Monday, September ]5,2074 <br />