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477. BACKWATER PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> Installation Company Name and Contact Info:,EATTLE DRAIN SERVICE <br /> Date Backwater Prevention devi (BWD)was installed: la-/Z- I L Date this form was completed: )^/ <br /> Installation Property Owner Namk and Contact Info:SHARON POPE <br /> Property Address: 2309 CALIFORNIA ST EVERETT WA 98201 <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 a basement or level of the house that is at or near assumed sewer main elevation?la Yes alo <br /> Are there fixtures in the house located below the upstream sewer manhole rim elevation?4es n No <br /> Is the side sewer currently UNPROTECTED from sewer backups (does not have a BWD installed)?*(es o 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?)(Yes i No Condition: U)c n.cn U t . <br /> Does side sewer have at least 1% slope from the building to sewer mein' es I I No Describe: <br /> Have all building sewer drain connections to the side sewer been identified and located?,es ii No <br /> Have all property storm drainage connections to the side sewer been identified and located j s a No <br /> Has property been evaluated for drainage deficiencies with findings ccmmunicated to property owneres I I No <br /> Installation Details: <br /> What type and brand of BWD was installed at this site(Clean Check BWV,Grinder pump,etc.): Cle . cAvx <br /> Where was the device installed(general description, attach <br /> C�map)? 0 t� -stC' `-tk c\,N (A...)G,. V <br /> 1 ey Wir U ni4- % Co Pe re e (Ph I` <br /> Was there any other sewer or storm drainage work completed in conjunction with the BWD work? Is so please describe: r1O <br /> Installation Checklist: <br /> Are all downspouts and site drainage disconnected from upstream of to BWD? i c Llo Comments: <br /> Does BWD positioning meets minimum slope requirement of>1%?1110. No Comments: <br /> Can BWD be pulled out for inspection and maintenance after loosening thumb screw? lb dVo <br /> Is BWD locked into the proper position and humb screw tightened u No <br /> Circle the BWD,cover irrigation cove landscape area)!traffic load bearing cover(drive surface) I access hatch (building) <br /> Was property owner shown the location of the installed BWD. n Yes I No Comments: <br /> Property Owner's Signature; fla.YLt9'V`� P Date •` <br /> /Z <br /> Installers Signature t(Q4v2J6'' Date: ^c .0 ,.aottf <br /> Revision:2 1 Monday, September 15,2014 <br />