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BACKWATER PREVENTION DEVICE FINAL <br />INSTALLATION CHECKLIST <br />Ili Men cczn �r� Y ;; e:r LLG <br />Installation Company Name and Contact Info:--T' ' Lc&, ([j <br />Date Backwater Prevention device (BIND.)was installed: I 1 4 Date this form was completed: _ L j (_.LI <br />Installation Property Owner Name and Contact Info: ed iti So r)" <br />Property Address: 7o�i �2, �( /�r,i.—,,-1-4— , 714 �o <br />Pre -Installation Inspection Checklist: <br />All items must be checked 'Yes' in order for a BWD to be considered for installation <br />Is there abasement or level of the house that is at or near assumed sewer main elevation? [°Yes ❑ No <br />Are It ere fixtures in the house located below the upstream sewer manhole rim elevation? 3 Yes [IN. <br />Is the: side sewer currently UNPROTECTED from sewer backups (does not have a BVVD installed)? GKes Ej No <br />Site Inspection Checklist: <br />All items must be checked 'Yes' before inspection is considered complete /� ) <br />Was side sewer TV inspected from building to sewer main? ayes ❑ No Condition. (�?Y <br />Does side sewer have at least 1% slope from the building to sewer main? E3Yes ❑ No Describe: <br />Have all building sewer drain connections to the side sewer been identified and located? ❑ No <br />Have all property storm drainage connections to the side sewer been identified and located? El es ❑ No <br />41 <br />Has property been evaluated for drainage deficiencies with findings communicated to property owner? [a-Y�es ❑ No <br />Installation Details: <br />What type and brand of BWD was installed at this site (Clean Check BWV, Grinder pump, etc.): L 9 <br />Where was the device installed (general description, attach map)? S(- <br />Was there any other sewer or storm drainage work completed in conjunction with the BWD work? Is so please describe <br />Installation Checklist: <br />Are all downspouts and sits drainage disconnected from upstream of the BWD? [ifs ❑ No Comments: <br />Does BWD positioning meets minimum slope requirement of >1 %? [TYes ❑ No Comments: <br />Can BWD be.{LUlled out for inspection and maintenance after loosening th mb screw? [es ❑ No <br />Is BWD IockeoM16 the proper -position andthumbscrew tightened? [V Yes ❑ No <br />Circle the BWD copver: irrigation c�ver 19n scape area) I traffic load earing cover (drive surface) I access hatch (building) <br />Was property ow erS own the a location of the installed BWD? E Yes ❑ No Comments: <br />Property Owner's Signature: <br />Installer's <br />Date: p <br />Date: <br />Revision: 2• <br />Friday, September 12, 2014 <br />