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1 <br /> o � I <br /> ��,;j fiACKWATER PREVFNT'IQN DEVICE FINAIL ' . <br /> �w E�� INSTALLATION CHECKUST <br /> � <br /> ! <br /> i n � <br /> Installation Company Name and Ccntact Info: ��.��-i'�'1 �('��LL�S � i.�LU�1�iS Jl�;(��/�i C . <br /> I <br /> Date da�kv�ater Preveniion device (BWD)was inslalled: �E "I�'IS Dafe this form was completed: �I',-��.�`l <br /> Installation Properly Ov,�ner Name and Contact Info:�P�v�F,�S i�L�G�� <br /> ProperlyAddress ��..�v�k�fF��(L �P�� ��� ,..1���>� <br /> Pre•Installation Inspection Checklist: � <br /> All it2ms musf be checked 'Yes'in order for a BIND fo be considered for'ir�stallation <br /> Is there a basement or level of lhe house that is at or near assumed sevier main elevalion? es ❑ No <br /> Are there fixlures in Ihe house located below the upstream seiver manhole rim elevaiion? 4 es ❑ No <br /> Is lhe si�e sewer currently UNPROTECTED from sewer backups (does pot have a BIND installed)? es ❑ No <br /> Site Inspection Checklist: <br /> All items must be checked 'Yes'before inspectior is consrdered complefe <br /> Was side sewer N inspected from buiidiny to sewer main? es � No Condition� � � �✓'� <br /> Does side sev,�er have at least 1% slope from the building to sewer main? []-YLf ❑ No Describe� <br /> Have all building sewer drain connections to the side sevrer been identified and localetl? _ es ❑ No <br /> Have all property storm drainage connections lo the side sewer been id?ntified and located'? �es ❑ No <br /> i-las property been evaluated for drainage deficiencies with findings communicated lo property owner? C�`� � No <br /> Installation Details: ' <br /> What type and brand of f3WD was installed at this site(Clean Check BWV, Grinder pump, etc.):_��.e<..,. ��-e-e.�L- <br /> V��here vaas the device inslalled (general description, aflacn map)'? _ J'�� �`Ac-e}'�� __ <br /> Was theie any otner sewer or storm drainage work completed in conjunclion vdith the BWD work'? Is so please describe� /� <br /> i <br /> Installation Checklist: I <br /> Are all ciownspouts and site drainaye disconneGed from upstream of lfie BVdD? � ❑ No Comments: <br /> Does BUVD posilioning meets minimum slope requiremenl of>1%a? ��s ❑ No Comments: <br /> Can BWD be pulled out for inspection and maintenance after loosening�lhurn�screw? es ❑ No <br /> Is BIND locked inta the b screw tightened? �_ es ❑ No <br /> Circle tha BWD cover: n cover(landscape area !tra((ic load bear,ng cover(drive surface)!access hatch (building) <br /> !Nas property owner shoevn the location o(ihe installed BN.�D? es ❑ No Commenls: <br /> � — <br /> (P�opeity"Ovine�s'Signeturc ^�'I yr �,. Ef)ate' y- i �- /S <br /> Inslaller's 5ignature: - � . DateJ� !<) � <br /> kevision: 2 1 Monday,September 15, 701A <br />