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• edge BACKWATER VALVE INSPECTION <br /> CHECKLIST <br /> ow. 4,4:- <br /> Property Address: tO (1 14011`- <br /> BWV inspected by: I_ - wqoQu Date BWV was Inspected: : 10( zo r). <br /> 10,4\ ('IneC1c Val 10a vv.. 4 co r G(;re, d- s,r.S- 4,,ller' 2- 3 ?, 5 Q o <br /> Inspection Checklist <br /> Are all downspouts and site drainage disconnected from upstream of the BWV? ❑ Yes ❑ No <br /> Comments: S �Iawv.9(Jow S - tv Al,J-17 ec4(1- se w ; �low5 <br /> mn P <br /> �tw� ,axEry vise 5 Wei).: tA.-041 <br /> Does BWV positioning meets minimum slope requirement of>1%? ❑ Yes ❑ No <br /> Comments: NA <br /> Can BW'be accessed for inspection and maintenance? R1 Yes ❑ No <br /> Can BWV be secured into the proper position? Yes ❑ No <br /> Where is the valve installed (general description; attach map)? W.2 a--Fac -Ok <br /> tWO <br /> Is the installed BW 'considered an `approved' model by the City of Everett? Z/Yes — No <br /> Was property owner shown how to inspect and maintain their BWV? E Yes ❑ No <br /> Does this BWV require repair or replacement? ❑ Yes 11'1 No <br /> Comments: Flo 6(.21) - cm f ctra,,„, t I rt - LAM (b,ec14 v> v_ <br /> qpr,-A iv5 � b _ good 5pr,,,i u1_4-,... <br /> Inspector's Signature: Date: <br /> Revision: 2 Tuesday, September 23, 2014 <br />