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/ ' • . <br /> BACKWATER PREVENTION DEVICE FINAL <br /> I�lSTALLATION CHECKLIST' <br /> Inslzllztien Company Name and Coniact Into� .A��1 � �LL}S �L l�M i�1��(-, �N ( . _ <br /> Dale Baclnvaler Prevention device (BWD)was installed: I L fS D2,e this fcrm was completr,d • �- /r <br /> installaticn Prcoerty O�vner Name and Contact In(o: ,l m ME��oN ___ <br /> Propert,A�tlress: �]�j�Z'-1�ST � �J£�'� �.�����J <br /> Pre•Ir�stallation inspection Checklist: <br /> Ail itcros must be r,heck�d 'Yes'in crder,`cr a BWD fo he considered fer ins'a!(?;ion <br /> Is th:re a basement or level of the house that is at or r�ear assumed sever main eleva��on� � Yes ❑ No <br /> Are there iixfures in Ihe housF lor.ated below the upstream sewer manhoie rim elevation? [�Yes ❑ ��o <br /> Is tne side sev:er curentl,UNPROTECTFD (rom set:�er backups (dees not nave a BIND instalied)? [_�Yes [� No <br /> Site Inspection Checklist: <br /> /,4 items mcst 6e cheched `Y�es'bEfore insnection is corsidered ccmple!c <br /> Vdas s:ee se�aer N inspected from buildina to sevrer mai�? ��'2s ❑ tvo Cordition: ___._ <br /> Dces side s�v+er have at least 15b slope Frem the building to sev:er main? [�Yes ❑ No Describe: _ <br /> f iave all bul:ding sev+er dr2in connec6ons to the side ser;er be�n identiiied and located? ✓es ❑ No <br /> I lave ali property sform drainage conneclions to the side se.��er oeen identiEed and lecated7 �L .s ❑ No <br /> Has propery been evaluated for drainage denci�ncies vrith findings communicated to property eevner? (�]Yes ❑ No <br /> Installation Details: <br /> VJhai type and 6rand of B��lD was installed st this site(Clean Chec{c BbVV, Grinder pump, efc.): ��� � �� 3�<< �L�-e <br /> i�W� <br /> V:4irere �vas tf•�e device installed (general descripticn, aflach map)? i� "��e 6��s�.�.�.;,- �n s .3 <br /> ._ T/o-z,� !•�r�--�L -- <br /> 4Vas there any other sewer er storm drainagc v�ork c,�mpleled in conjunciion �vifh the f34VD work? Is so please describ� _ <br /> Installation Checklist: <br /> Are all do�vnspouts and site drainage disconnec;ed from upsUeam ot the BWD? �Ye� ❑ No Commenis:______ <br /> Does DWD posllioning meets minimum slope requiremenf o(>1%,7 (_� 'es ❑ No Comments: _ _ <br /> C��n 84VD be pulled out(or irspecGon and maintr,nance after loo:;ening Ihumb scre�.v% ✓(�Yes �] No <br /> Is BWD locked into ihe proper positiun and thumb sc.rew lightened'? �Yes ❑ r�o � <br /> Cirde the a4^!D cover irrigation cover (landscape area)I traffc load bearing cover(drive�rface)I acce�s hatch {building) <br /> i <br /> !'das proper�y o�r+ner shown the Ixation of the inslalled ����lD? i' Yes ❑ Nn Comments: _____ __ <br /> I } ' <br /> Prbpedy Owner's Siynature:_. . _ � L���_-_----- Da�e: 3 �3 _ <br /> Inslailer's Signafure � __ __ _-_� Date: _� 17,� /� _ <br /> � 7 T— <br /> Itevision: 2 1 Manday, Sepfember 15, �O]A <br />