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BACKWATER PREVENTION DEVICE FINAL_ <br />4WTT <br />INSTALLATION CHECKLIST <br />Installation Company Name and Contact Info. o wr s� BueT!®�F ld�rJ� az-S <br />Date Backwater Prevention device (BWD) was installed: 7416 1 pA5— Dale this farm was completed: 7 l S <br />Installation Property Owner Name and Contact Info: �85dM1tIe� PF G� <br />Property Address: %kF F / t'a 1:14-; / <br />Pre -Installation Inspection Checklist: <br />All items must be checked 'Yes' in order tot a BWD to be considered for installation <br />Is there a basement or level of the house that is at or near assumed sewer main elevation? 13 Yes ❑ No <br />Are there fixtures in the house located below the upstream sewer manhole rim elevation? r Yes D No <br />Is the side sewer currently UNPROTECTED from sewer backups (does not have a BWD installed)? L' Yes I] No <br />Site Inspection Checklist: <br />All ilems must be checked 'Yes' before inspection is considered complete <br />Was side sewer N inspected from building to sewer main? U Yes ❑ No Condition: <br />Does side sewer have at least 1% slope from the building to sewer main? B'Yes ❑ No Describe: <br />Have all building sewer drain connections to the side sewer been identified and located? Imes ] No <br />Have all property storm drainage connections to the side sewer bern identified and located? Vs I] No <br />Has property been evaluated for drainage deficiencies with findings communicated to property owner? F Yes ❑ No <br />Installation Details: <br />What type and brand of BWD was installed at this site (Clean Check BWV, Grinder pump, etc.): _ Lem eltee K <br />Where was the device installed (general description, attach map)? In9-C 5 r tom' <br />Was there any other sewer or storm drainage work completed in conjunction with the BWD work? Is so please describe: _ <br />AID <br />Installation Checklist: <br />Are all downspouts and site drainage disconnected from upstream of the BWD? Des ❑ No Comments: <br />Does BWD positioning meets minimum slope requirement of >1%? ofes F] No Comments: <br />Can BWD be pulled out for inspection and maintenance after loosening thumb screw? F!rYYes I I No <br />Is BWD locked into the proper , fro anan winb screw tightened? [']''Yes CI No <br />Circle the BWD cove . rrigation (landscape area) / traffic load bearing cover (drive surface) / access hatch (building) <br />Was properly owner shown -"cation of the ins alled BWD? Fa'Yes ❑ No Comments: <br />Property Owner's <br />Inslallrr's signalur <br />Date: '7 /t'0 <br />Date: <br />Reviyiun: 2 1 Monday, Seplunih r I S, 2014 <br />