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BACKWATER PREVE <br />INSTALLATION <br />Installation I ompany Name and Contact Info: t,� 1,11 P ^ L <br />Dale Backw ter Prevention device (BWD) was installed: <br />Property Actress: <br />Pre-Installal ion Inspection Checklist: <br />All items mu f be checked 'Yes' in order for a BWD to be considered to <br />Is [here a ba ement or level of the house that is at or near assumed se, <br />Are Iheru fixtures in the house located below the upstream sewer manh <br />Is the side s Iwer currently UNPROTECTED from server backups (does <br />Site Inspection Checklist: <br />All items mu t be checked 'Yes' before inspection is considere <br />,_� d .c,om <br />L�( <br />Was side sewer 1V inspected from building to sewer main? Ye, <br />Does side sever have at least 1 % slope from the building to sewer it <br />Have all buil ing sewer drain connections to the side sewer been ide <br />Have all prop arty storm drainage connections to the side sewer been <br />Has property, een evaluated for drainage deficiencies with findings c <br />Installation Details: <br />What type anal brand of BWD was installed at this site (Clean Check <br />Where was the device installed (general description, attach map)? _ <br />Was there an�, other sewer or storm drainage work completed in <br />Installation <br />Are all dovrns,routs and site drainage disconnected from upstream of th <br />Does BWD positioning meets minimum slope requirement of >1 %? <br />Can BWD be,pulled out for inspection and maintenance after loosening <br />Is BWD locked into the proper position and thumb screw tightened? <br />Circle the BWQ cover: irsyJ�' r lake ar affic load be <br />- <br />Was property,owner shownl ie loca o�ot the rnsta d BWD? Yes <br />Proppq 0!7r ir's signature: <br />Installer's Signl lure: =2 ✓ <br />Revision. 2 <br />1 <br />N DEVICE FINAL <br />HECKLIST <br />Date this form was <br />9 <br />27 <br />installation <br />or main elevation? ZYes El No <br />le rim elevation? C1Yes ❑ No <br />tot have a BWD installed)? Yes ❑ No <br />No ondiIion: <br />Yes ❑ No escribe: _ <br />and located? [Yes ❑ No <br />led and located? dyes ❑ No <br />to property owner? ❑ Yes ❑ No <br />,Grinder pump, etc.): eon r-ti_, <br />with the BWD work? Is so please describe: N <br />VD?" Yes ❑ No Comments: <br />i ❑ No Co efils: <br />escrew? Yes ❑ No <br />s ❑ No <br />cover (drive surface)! access hatch (building) <br />No Comments: <br />*-*. Z7 <br />Date: <br />Monday, September 15. 7ni4 <br />