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■� Jul. l6 2015 );49AP! ,Snafiomish Na. 5103 P. I � <br /> .._.Ican..,......... .....�er 425-252•SBiv p.t <br /> r � l <br /> � � I <br /> •� `:: �B�CKWATER PREVENTION DEV(CE FINAL � <br /> i <br /> �, INSTAL.LATION CHECKL,IS7 . � <br /> l <br /> � ��cun � �� �r ��de � e�:�', ` Le j <br /> ,� �„�� _ix�iK'r. /1 � ar.l �ii R' I <br /> Inslalla��CompanyNameandContacllntu: ��r ' C- � " �-•`'i�--��'�—�"}� i <br /> Date B��yater Prevenlion device(BWD)was inslalled: CL' U Date this lotm was compleled�� I <br /> "l�l.t:�le��--.�� --- � <br /> Insta{la Yion Property Owncr Name pnd Gonlect In(o: � fl � `��� ' i <br /> ProperriAddress: ��Od ,�`iYl �-�_,.,�—�Vp�I�Q�T 6 , <br /> I <br /> p�.�hstallaGon Inspec8on Cher.klisf: � <br /> A(1 iferr+-s musf be chRcked 'Ves'in o�derlor a BWD fo 6e considered for tnstellafion , <br /> is ihere a�a:ement or lovel of the house lhat is ai or near assumed eewer main eievation7�fes ❑No ; <br /> Are th������in ihe house locatod helow tl�e upslream setver manhole rim elevatlon4�Yes ❑ No <br /> 1 <br /> Is the side setver currenfly UNPROTECTED 6om sewer hackups(does nothave a BUJD insfal!ed)?�}Yos D No � <br /> Sitv Inspa�tion ChecklisL• ; <br /> All iloms must be checkod`Yes'6efcre inspeclion is onnsideled compielo �� � <br /> 4Vas side sewerTV inspecied from hullding to sewar main? �Yes ❑No Condipon: ; <br /> Doas side sewer hava al Ieast 1%siope from ihe bu�ding to sewer msin7 [�7res ❑f�o Describe: � <br /> Nave a►I bullding sower drain connec6ons In Ihe side sevier been identified and localed? [�'es ❑No <br /> Have atl p�operty sfo«n drainage connections to Ihe side sewer been idenllflad and locafed? �7i'es ❑No <br /> Has propedY been evaluoled for drainage deficiercios�vith findings communicated lopropetty otmec? �'es ❑No <br /> installation Ootalls: <br /> What typ�2nd brend oi BWD�vas Installed at Ihis site(C(ean Cheek BWV,Grinder pump,e��•Y —_�� 1+_ <br /> Where was the device inslalled(guneraf description,allach map)? ��� -- "� <br /> y�r�s���ore any other sewer or swrm diainagu v,o�k completed in con)u���I�6WD ti'ro�k?Is so plr.ase describe�� <br /> _--�---- <br /> Installation Checklist � No Commenha:_ <br /> Are all dow�sp�uls and sile drainaqe disconnecled 6am upstroam ot tiie BWD? �Ye� ❑ - <br /> Does BWp P�silioning meels minimum slope requlrement oi>1%Z �Yes �]No CommenL:_________�- <br /> Can BW� be pulled oul(nr insp;Gion anJ maintenance aiter loosoninp thurnb serr,vR,0'Yes ❑No <br /> Is BV�'D locked inlo thr.proper posifion and�humh sciew Gghlened?�Ye., ❑No <br /> Gir�ae 1he BIND wve irrigalion cove�ndscape area)llra�ic�oad bearing wver{drive sudace)!acwss haUh(huilding) <br /> y�r3�p�pe�ty owner shnwn ltie Io�aGon of the inslalleJ dLND? (�'es ❑No Commenls: ,_____ <br /> ' oato:_�"/�d'��-- <br /> �Properiy0wner'sSignature: _ ��-�--- � �� <br /> Dale:_�� <br /> Insfallers Sipnature:__���� — --- -- , <br /> 1 priday, Soptcmber]Z,7U1A <br /> Re'vision�2 <br />