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047.7 BACKWATER PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> Installation Company Name and Contact Info: kileg.0QLvw i rut (n — 4 LcCe -- Cfi`z--f <br /> Date Backwater Prevention device(BWD)was installed: i t - t 2. —i4 Date this form was completed: t L's.' 1'3 r t Qk <br /> Installation Property Owner Name and Contact Info: <br /> Property Address: <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? N Yes ❑ No <br /> Are there fixtures in the house located below the upstream sewer manhole rim elevation?(J Yes ❑ No <br /> Is the side sewer currently UNPROTECTED from sewer backups(does not have a BWD installed)? 7,1 Yes ❑ 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? RI Yes ❑ No Condition: IQ =e 1 au S <br /> Does side sewer have at least 1%slope from the building to sewer main? .-( Yes n No Describe: <br /> Have all building sewer drain connections to the side sewer been identified and located? iz Yes ❑ No <br /> Have all property storm drainage connections to the side sewer been identified and located? Yes ❑ No <br /> Has property been evaluated for drainage deficiencies with findings communicated to property owner? Yes ❑ No <br /> Installation Details: <br /> What type and brand of BWD was installed at this site(Clean Check BWV, Grinder pump, etc.): C G e u dike c <br /> Where was the device installed (general description, attach map)? &ic a- ri O- / e,,;CDl u&L <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 site drainage disconnected from upstream of the BWD? M Yes ❑ No Comments: <br /> Does BWD positioning meets minimum slope requirement of>1%? cg Yes ❑ No Comments: <br /> Can BWD be pulled out for inspection and maintenance after loosening thumb screw? M Yes ❑ No <br /> Is BWD locked into the proper position and thumb screw tightened? [X(Yes ❑ No <br /> Circle the BWD cover: irrigation cover(landscape area)I traffic load bearing cover(drive surface access hatch uilding) <br /> Was property owner shown the location of the installed BWD? ❑Yes n No Comments: <br /> Property Owner's Signature: Date: <br /> Installer's Signature. Date: A' — <br /> Revision:2 1 Friday,September 12,2014 <br />