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� BACKWA7ER PREVENTION DEVICE FINAL <br /> INSTA�LATIOIV CHECKLIST <br /> Inshellation Compeny Name and Contact Inlo: +��{���.5� S- ��j0 �'" p'� ��� <br /> Oate Bac;.water Revenlion device(BWD)was installed: Dale thb ierm was oompleled: <br /> Ins[ellalion RopeAy Owner Name and Contad In`o:��Qt���g� �r' <br /> ProperlyAddress:y�u.�i,'� 1.,U._�,�.r a.,1p +.Y'�fJo�: A�.� 1 <br /> � '� <br /> Pre•Inet�IleBon Inspeetlon Chxkllat: <br /> A!1 ilems must be cheeked'Yes'in ader tur a 8WD to be considered Iari�fellafian <br /> h Ihere a basement w ievel o(the house Mat is et or near esaumed sewer main ele��ation7�Yes ❑No <br /> Are Iherefutures fn the house lorated bebv�Ihe upstream sewer manhofe rim eleva6on7�Yes ❑No <br /> Is Ihe side sev+er aurendy UNPROTECTED hom sewer backups(does nol have a fiWD inshalled)1,�Yes �No <br /> v�- <br /> Slte 1nsp�dion Cfiadclist: <br /> Ap Bems musf ba 4recked'Yes'6e(o�s ins�ection is calsidered compfefe <br /> Was side sewer N inspeded irorn building to sewe�main? �Yes ❑No Cadition: <br /> Does siQa cawer have at least 1%slope hom Ihe Duibing to xwer main? �'Yos �No Descnbe: <br /> Have all buading sewerdiein connections lo the slda sewer been identfied end IocaleJl �Yes ❑No <br /> Mave all propeR�stam dralnage mnnedions to the side sewer been iderdi6ed and located? �Yes ❑No <br /> Has property been evaluated fat dtainage deficiencies wilh findings co�rununkaled to properry ame�? �Yes ❑No <br /> Iruhtlatfan Detalla: <br /> Y4hat lype and brand ot�D was imWlled a[Ihis sim(Clean Check BWV,Grinder pump,etc.):��„`�,°f��.� <br /> Where was Ihe devicx InstaNed(generel desaiptian,atlach map)? i1�P n-�L.,�jw���f1(.�.c �� <br /> Was lhere any olher server or stam dralnage vrork completed in canjunctlon wAh the BWD wwill Is so please descri6e:` <br /> d� — <br /> Instdllatlon ChecklisY <br /> Ma all downspouh end s'As drainag9 d'sconnaded irom up9tredm of Ilfe 9W07 �Yes ❑No COmrtknls: <br /> Does B4VD positbning meets minimum slope requirement ot>196? Q�Yes ❑No Camments: <br /> Can BWD De pulled aul fM InspecUon end maintenance eMer bosenlnp Ihumb saew? [�Yes ❑No <br /> Is BWD bcked intn fhe 'on and thumb screw flgMenedl f�Yes ❑No <br /> Circle the BWD oov :ir�gaUon cover landscepe erea)ltralfic load Eearing aover(drive surfaoel!aaess hatcA(DulMing) <br /> Was propetly owner sMwn the brab'on�f ihe inslalled 81ND7 �Yes �No Commenfs' <br /> /�l"'� <br /> Roperty0wmer'sSgnature: f' ` �e: � � �/ <br /> Inslallei'sSignature:� �: �n�--..---- <br /> Revision:2 1 Friday,September 12,2014 <br />