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BACKWATER PREVENTION DEVICE FINAL <br /> �� _ INSTALLATION CHECKLIST <br /> Inslallation Company Name and Con�acl In(o�n��L��i�FSi�ucT �F ld���c�s <br /> Daie E3ackwater Prevention devir.e (BWD)was inslallr.d:��5� flale Ihis loim was cumplclr.d 7 .�/l5� <br /> Insfalla�ion Properi��Owne� Name and Crmtact Info: �6��M�y�_J�-Gf�MM�__ <br /> __. _ <br /> t1� � <br /> ��o���ryndd«SS: 1(�I ( I� �� <br /> Pm-Installation Inspection Checklisl: <br /> /111 items must be checked 'Yes'in ordcr for a BWD fo be r.nnsidcred(or insfaU��finn <br /> i <br /> Is iherc a basemeni or level of ihe hnuse thal is al or nr.ar assumed sewer main clevalion? �.`�Ye; �_]No <br /> Are ihere fixfures in the housc localed below thc upsiream sev,�er manhole rim elr.valion?��es ( � tJo ! <br /> Is the side sewer currently UNPROTGCT[D(rom sewer backups(does nol hnvr. a f3�NU inslalled)?I�5 �__� t�� I <br /> Site Inspection Cliecklist: <br /> 1111 items must be checked 'Yes'be(oie inspeclion is considered complele - <br /> �Nas side sewer 1V inspected(rom building lo se�ver main? [�]Yes ❑ No Cundiiion: . _ _..___ <br /> Does side sewer have at least 1% slope from lhc building lo sevrer main? �_'�"Yes [) Nu Describe:_ <br /> Have all 6uildiny sewer drain c:onnecfions fo lhe side sewer heen idenlified and localed? [�1'r,s �_�No <br /> I lave all nroperty storm drainage connec(ions to the side sewer been idenlified and lor,aled? �.�es ❑ No <br /> Has properly bcen evalualed for drafnaye de(iciencies v�ith findings coinmunir:aled lu properry owner? [�'j�Yes �_] Nc� <br /> Installation Details: <br /> What type and brand of BWD was inslalled al this sife(Clean Check BWV, Grinder pump, elr,.):_�!-C/1�1 CI�'�C K <br /> Where�vas Ihe device inslal�^.d (yeneral descripfiun, al�ach map)? _1,�9-�h i� <br /> Was Ihere any olher sr.wer or sloim drainagc work cornplelr.d in conjunr,(ion wilh�he 4WD�vork? Is so please descril�e: <br /> --- - -��' -- --- -- ---_ i <br /> Installation Checklist: �/ - � <br /> �re ail downspouls and si�e drainage discnnnr.r,ir.d from ups�ream ol�hc E3WD? r'j Ycs [] No Comrnenls <br /> Does BWD posilioning mecis minimum slope requiremenl of >1%�? �.�� rr�s [_� No Commenls�_.__ _ � � <br /> Gan HWD be puilr.d oitl for insper.finn and mainlenance afler loosening Ihumb screw? � ''�r.s � �No <br /> Is �bVD locked inlo the pmper�n+sit��aniUhumD sciew liphl�;nr,tl? [�Yr.s �� � Mo <br /> Cirdr. ihr, f3WD cove : Tigalion� uc�((landsr.ape a«:a)1 tr�if(ic load bearing cover(drive suiGice)I�iccess hafch(buddinq) <br /> lNas property owner shoU ,, calion of Ihr. in�d [3WD? ��s � .� Nn Cc�mmenls <br /> Property Owner's 5ignalu�ii -- � �alc _�_���S <br /> - — - — — _-_ - <br /> Inslalh;i';; Sinnalurc �-`�- � -�L-`'^ _. __ D:de: 7�z�9//S <br /> Rcvi•.inn. ? I f✓uinddy. `.,rpl�•inhrr IS, 701�1 <br />