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f f f <br /> 477. - BACKWATER PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> Installation Company Name and Contact Info: 4 4 p hirok 11_C 47 /B <br /> Date Backwater Prevention device(BWD)was installed: Date this form was completed: 11 <br /> Installation Property Owner Name and Contact Info: AU,61/4/14! -1 � - '3b-7"7 S (88 <br /> Property Address: .i 1 '/ L,6WUtO O d <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? ❑No <br /> Are there fixtures in the house located below the upstream sewer manhole rim elevation?Plis El No <br /> Is the side sewer currently UNPROTECTED from sewer backups(does not have a BWD installed)?EPtCs ❑No <br /> Site Inspection Checklist: <br /> All items must be checked'Yes'before inspection is considered complete 0�✓ <br /> Was side sewer TV inspected from building to sewer main? XG�s El Condition: /�l9-PI vnn b/ Ku, <br /> [U /7 <br /> Does side sewer have at least 1%slope from the building to sewer main? ❑No Describe: <br /> Have all building sewer drain connections to the side sewer been identified and located? [l�''�es ❑ No <br /> Have all property storm drainage connections to the side sewer been identified and located? ❑No <br /> Has property been evaluated for drainage deficiencies with findings communicated to property owner? E I C' ❑No <br /> Installation Details: <br /> What type and brand of BWD was installed at this s' (Clean Check B1 , Grinder pump,etc.): di-e"i-C/4-e-a--(----W <br /> was the device installed(general description,attach map)? ( ieu'tti) <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? []ems ❑No Comments: <br /> Does BWD positioning meets minimum slope requirement of>1%? [fifes ❑No Comments: <br /> Can BWD be pulled out for inspection and maintenance after loosening thumb screw? [ ❑No <br /> Is BWD locked into the proper position and If I crew tightened? ❑No <br /> Circle the BWD cover. irrigation wirer(landscape a /traffic load bearing cover(drive surface)/access hatch(building) <br /> Was property owner shown the location of the installed BWD? PiciEj No Comments: <br /> Property Owner's Signature: vw+r Date: 3(27/ 15 <br /> Installer's Signature: (2,eaX21 1 <br /> Date: �`"1`47"_ <br /> Revision:2 1 Friday,September 12,2014 <br />