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`� <br />BAC�iWATER pREVENTION DEVICE FINAL <br />INSTALLATION CH�CKLIST <br />Inslallalion Company Name antl CoNact <br />Date Backe:ater Pr <br />Installation Properl <br />Praperty Address <br />Pre•Installation Inspection Checklist: <br />All ilems must be che:ked 'Yes' in o�der lor a BWD to be considered for installation <br />Is Ihere a basement or level ot Ihe ho�ae Ihat is at or near assumed sewer main eleval�on ��] Yes ❑ No <br />kre there fxlu� es in Ihe house located below the upsUeam sewer manhole rim elevalion? [fj Yes ❑ No <br />Is fhe side sewer currently UNPROTECTED (rom sei:�er backups (does not have a B4VD inslalled)?� Yes ❑ No <br />Site Inspectian Checklist: <br />All items must he checked 'Yes' be%re inspectron is considered com(lete <br />1%Vas side sc�ver TV inspected from building to sev�er main? Q Yes ❑ No Condilion _ <br />Does side sewer have at leasl 1% slope from the building to sewer mzin? ��Yes ❑ No Describe _ <br />Have all building sewer drain connecli�;is to lhe side sewer 6een identifed and located? �] Yes ❑ No <br />Nave all property storm drainage cnnneclions to Ihe side se�ver 6een identified and located? � Yes ❑ No <br />Has property been evalualed (or drainage deficiencies �vi1h findings communicated lo property o�vner? �] Yes L No <br />Installation Detaits: /1 f � r1 �_ U <br />Whal type and brand of BIND was inslaGed at this site (Clean Check 8��n�/ G�ri�npder pump, etc.): <br />lN�e �vas Ihe dev;ce installed (general descriplion, allach map)? ti./ lti7 �(°�� <br />INas there any otl%r sewer or slorm drainage ��ork cq�npje�ted in conjunciion Nnlh lhe �1N0 work? Is so ple3se describe _ <br />Installation Checklish <br />� <br />Are all do�vnspouts and site drainage disconnecled (rom upslream ol Ihe BWU? ,(� Yes ❑ No Comments. <br />Does BWD posilionmg meels minimum slape requir, nenl 0(>1%� Yes ❑ No Commenls: <br />Can BIND be pulled out for inspection and mainlenance a(ter loos ning Ihumb screw? �Yes ❑ No <br />Is BWD locked mlo the praper position and Ihum6 scre�v tightened? �% Yes ❑ No <br />Circle lhe BWD covec irrigalion cover (landscape area)! traKc loa�earing cover (drive sur(ace) I access halch (huildmg) <br />14�as property owner shotivn the location o( <br />Property Ovmcr's Sii <br />Insfaller's Signature: <br />Revuiore 2 <br />�Yes ❑ No <br />Commenls. <br />Dale: � z"—�� <br />Date: `'��— 2 — � � <br />Friday, September 12, 20:4 <br />