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• /' <br /> .� <br /> � � BACKWAT�R PREVENTION DEVICE FIN!AL . <br /> _ IN�STALLATION CI�ECKLIST <br /> Insfallatiop Company Neme and Contacl Inlr. ���+Q� � � �5 � ✓�'���ti�1� - �^� � - <br /> i <br /> Date Backwater Prevenlion device(BVJD)was installed: Date this form was completed: �' - <br /> Inslaliation Property Owner Name and Conta;t Info: M�uIAF�. � 170G9h� <br /> PropeRy Address: ��605 WETwu�E �E. �JE(1E.IT Gvq qFSZ6 1 - <br /> Pre-Installation Inspection Checkiist: ' <br /> All items must be checked'Yes'in order(or a BWD to be considered(or installation <br /> Is Ihere a basement or level of tha house thai fs At or near assumed sewer main elevation?lNres ❑No <br /> Are lhere fixlures in the house located below the upstream sewer manhole rim elevafion? w es ❑,_,/No <br /> Is the side sewer currently UNPROTECTEG(rom sewer backups(does nol have a BWD installed)?Lvlves ❑No <br /> . Site Inspection Checklist; <br /> All ifems musl be checked'Yes'belore inspection is considered complete <br /> Was side sewer N inspected from building to sewer main? [�'�es ❑No Condition: �icm� <br /> Does side sewer have at least 1%slope:from the building to sewer main? Q Yes ❑No Describe: <br /> H�ve all building sewer drain connections lc�lhe side sewer been identified and located? (�'es �No • <br /> Have all properly storm tlrainage conneclions lo the side sewer been identified and located? �es.0 No <br /> Has property been evaluated for drainage deficiencies with findings communicated to property owner7 �Yes ❑ No <br /> Installation Deta:ls: ` <br /> Whai type and brand o�BWD was inslalled at this site(Clean Check BNN,Grinder pump,etc.): CLEI�-� Ct�C1L <br /> VJhere was the device installed(general description,atlach map)? MPn� A�n-P.c�4£O <br /> N�as lhere any other sower or stcrm drainacls work compl�;ed in conjunction wilh the BWD work? la so plesse d2scrib;;:_ <br /> QPv���- nwn��� <br /> Installation Ciieckiist: ,_,/ <br /> Are all downspouts and site drainage diswnnected trom upsfream of the BWD? Uv Yes ❑ No Comments: <br /> Does BWD posilioning meets minimum slope requirement of>t%? Uv res ❑ No Comments: _ <br /> Can BWD be pulled out for inspection and maintenance atter loosening lhumb screw? (�'Ves ❑No <br /> Is 4WD locked inlo lhe proper position and ihumb screw lightened? t�Yes ❑No <br /> Circle ihe BWD cover:irrigation cover andscape area)I traffic loa�ring cover(drive surface)I access hatch(building) <br /> Ulas property o�vner shown Ihe location of stalled BWD? es ❑ No Comments:__ _ <br /> Property Owner's Signature: //� Date: ���'�� — <br /> —t— <br /> Installer's 5ignature:�� - Date: 12 �2�!`� <br /> ftevision: 2 1 Monday,September 15,2014 <br />