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BA(;KWATER PREVENTION DEVICE FINAL <br /> Ey INS�'ALLATION CHECKLIST <br /> insiallaiion Company �lame and Ccnlacl !nfo: ° � �[�G��+ '����� <br /> Date Dack.�aal?r Pre��2ntion dewce (BWDI w:s instal!ed 1— r0 �} �:f�-this `crm ;;as completed. i ZI�I 11� <br /> Insta!lation Property Oemer Name znd Conlac� Inro �]},S',�(,�1r k _ <br /> Property P.ddress �' i-i�I�' ,�'r �E <br /> � <br /> Pre�lnstallation Inspection Checklist: <br /> All rtems must he ch=cked'Yes in order k;r a B'1JD to be considered(or inslallaGon <br /> Is th�2ra a basement or level of Ihe house that is at or near assumed se�eer main el2valion?.�] Yes L] h:o <br /> Are fhera fixtures in fhe house tocated �:Ic:;the upsirean�� se�.ver manhule rim e!eva!ion?� les ❑ �i_� <br /> Is lhe side se:��e�a�ren;ly U`!?ROTErTE� `rcro se:�er hac-:��.:�:� id�a7 eci iia��e a 5l'vD in<.'ai'ed17�; Ye� � �do <br /> Site Inspection Checklist: <br /> All items musf ba checked 'Yes't�e_�r �r;.::zho,^ is r„-r:si�:::e�r.nrnplets <br /> V�'as side sev�er TV inspec.ted from huildirg 10 se�.ver main� [� 'r'es ❑ PJo Cnr�di!ion __ _ <br /> Does side sevrer ha��e aI leasf 1% s!ope(rom the building to se:�:er main% � 1'es [] No Describc _ _ <br /> Nave all building sewFr draln conne�tions fo the side se�ver been identifed and located? � Yes ❑ "Jo <br /> Have all property storm dra!nage connections to lhe side sewer been idenlified and Io:,�1ed? �Yes (_j N� <br /> Nas property been evaivated fcr drainage deficiencies wilh fndinqs cnmmunicated to property oxner?X�_� Yes J ?1_ <br /> Installation Details: <br /> 1h'hat lype and brand of BWD wa� instalied a! l�r� �i!e (Clean Chec; Bb�nJ, Grinder p�r�p,efc.�: CG�� ��G 5 Qrp/`� ��� <br /> VJhera vras the davice insf�alled(gereral descripti�,n, ';'ach map)? �1'1�C�_y,_�{7,�Jti�\1� �' �' `. � ,�- � _ <br /> lVt 1�:1G�'��iN�R-ttK ��� ��,�t_1r1.n ��1f-1- �t 'L�'--l�' --� <br /> Was lhere any other sewer or storm tlrainaye�vor:�coinpietr-d in conjunction �,v,lh lhe BVJD �tiark? Is so Fil�;ase descnbe _ <br /> �'1 U --- <br /> Installation Checklist; <br /> hre all downspouis and site drainage discomiected from upstream o(ihe E3WD? [� 1'es � No Commenls. ___ <br /> / ' <br /> Does 6WD pos�tioning mee�s minimum siope cequirement of>1°a? (�,1 Yes ❑ No Comments. _ _ _ <br /> Can BVJD be puiied oul fnr inspection and maintenance afler Ioosening Ihumb screw7 �j 1'es ❑ No <br /> Is f3WU locked into lhe proper position and thumb screw tighlened? [�Yes ❑ No <br /> Grcle fhe BWD cover irrigalion cover Qandscape area)I Ira(fic load bearing cover(drive surfaee)/�ccess halch �buildinc'� <br /> VVas property o�vner shov:n Ihe localion of ihe ins�alled BWD7 �] Yes ❑ No Commenls: _ <br /> //� 7 <br /> x Propert/Otivner's Signafure. f! �� G ��r✓� � Gate:� � �Y <br /> Installer's S gnab�r � :; � ' r �.�-P Dale:�?JI I��I <br /> nevision � 1 Friday, Septemher 12, ZOlA <br />