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� Backwater �Prevention Device <br />. Property Owner Rebate Form <br />Please verify the following items: <br />I am the owner of the property served by the side sewer where thP Backwater <br />Prevention Device was installed. <br />�worked witli my contractor to determine the installation location for the Backwater <br />Prevention Device. I understand that the final decision regarding installation location <br />was mine. <br />�he Backwater Prevention Device was installed on my property: <br />• I have been shown ho�v to access, inspect, and maintain my device by my <br />contractor <br />• I understand the City m�ill not maintain lhe Backwater Prevention De��ice. I <br />am exclusively responsible to maintain i[ and to keep it in good tvorking <br />order. <br />• If I sell my property, I v✓ill make the buyer aware of the Backwater <br />Prevention Device and the need to maintain it. <br />Choose one of the following; <br />s of now, my property has no dovrnspouts ar other onsite drainage that connects to <br />the side sewer upstream of the installed Backwater Prevention Device. <br />or <br />❑! still have downspouts or other onsite drainage thal connects to the side sewer <br />upstream of the installed Backwater Prevention Device. I understand that leaving these <br />connections means that the risk of flooding frorn downspout or onsite drainage remains. <br />i accept that risl<. <br />_�� S!�nature�/��L�Mka- � 41 .�.r�- Date � � - � �' �y <br />I <br />Page 2 of 2 <br />Revised 09I09I2014 <br />