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:� <br />�ACKWATER RREVEfVTIi7fV DEVICE FIN�L <br />IN�TP,LLAYIA�I CaiEC�CLIST <br />Insiallailon Company Name and Conlact Info�� <br />Date Bacln�raler PrevenUon devk;e ({3VdD) was insta <br />In5tallation Proporly Owner Name and Contact fnio: <br />Proporly Address �.0� � u-�� <br />Cal'1 f�Df � � <br />� <br />��s��. �..uw�via�.i.��[a�c3iz716'{oi� <br />�. • 1 �(�1 : •1 � <br />�� <br />pre•fnstallation inspoction Checklist: <br />AI( ilems must be che:;kod 'Yes' in arderfor a 8WD fo be considered (or in;rallation <br />...,./...ilA � <br />Is there a basemenf or level of the house that is at or near ass�.�Mnr±;ewer main elevalion7 (�Yes ❑ No <br />Are there fi�ures in the house located below fhe upstream se�ver manhole rim elevaL��n7 j� Yes ❑ No <br />Is fhe sido sev;er currentiy UNPROTECTED from sowor backups (does not have a BWD instalietl)? �Yes ❑ No <br />Site Inspection Chacklist: <br />AI(lfems must 6e checked 'Yes' 6efore inspecliai is considered complele <br />Was side sowar 7V (nsper,ted trom bullding to sewer main7 �Yes ❑ M10 Condltlon: ��� <br />Does side sovier havo at le�st 1%slope from the builtling 10 sewer main7 (�'Yes ❑ No Describe: <br />Have all building sewer draln conneclions to ihe slde sewer 6een identified and located? [�l'es ❑ No <br />Have all properly sto�m drainage connections to the slde sevrar been itlenlified and locetod7 [�'es ❑ No <br />Has property beon ovalua!ed for drainayo de(Icienclos wilh findings communicated to property ovme�l �Yes ❑ No <br />Installatlon �etails: <br />Wha! type antl brand of BWD wes insfalled at this sito (Clean Chcek BWV, Grintl�r pump, e�c.): � <br />Whnre, was tho device installod (goneral descriplion, atiach map)? rjp� ���-i� <br />4Vas thoro any olher sewer or storm drainage tvork wmpl �tad in conjunction wilh the BW� work? Is so please descri6e: _ <br />-�---- �:���- -- <br />Installafion Checklist: <br />Are all downspouts end sile drainage discnnnecled from upsUeam of the BWD? �'es ❑ No Commenls: ____ <br />Does BWD positionfng meels minimum slape requirement of >T%7 � Yes ❑ No Commenls: _ __ <br />Can BWD be pulled oul for inspecfion and maintenznce afler loosening lhurnb acrew? � Yes ❑ No <br />Is BWD Incked info Ihe pro er osilion and thumb screw tlgldenetll �i Yes ❑ No <br />Cin:lo the 8WD cov . in(gefion (landsc�pe area)! tra�lc loatl bsarin cover (drive surface) / a�cess halch (bulitling) <br />Was property ownor shown the I tlon oi heinstallod BlND1 �'es No Commenis: <br />Propetiy Otmer's 'goalu : Date: � / �� � <br />installer's Signalu . / � - Dala: <br />� <br />Revision:2 "� 1 Frlday, September 12, 2014 <br />