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l <br /> BACKWATER PREVENTION DEVICE FINAL <br /> 4.7 <br /> INSTALLATION CHECKLIST <br /> Installation Company Name and Contact Info: 1I'% fl', ,2, <br /> Date Backwater Prevention device(BWD)was installed: Date this form was completed: <br /> Installation Property Owner Name and Contact Info: 1-re.efris y 4.i c (65 ) 4/5s- f 9� <br /> Property Address: ZZeZ. ,nz,°oily,/ ,,gve i-ve'er--f- WA- /V. >/ <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? E(Yes ❑No <br /> Are there fixtures in the house located below the upstream sewer manhole rim elevation?[ Yes ❑ No <br /> Is the side-sewer currently-UNPROTECTED from sewer backups(does not have a BWD installed)? 4es ❑ 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 ❑ No Condition: <br /> Does side sewer have at least 1%slope from the building to sewer main? 'Yes ❑ No Describe: Z <br /> Have all building sewer drain connections to the side sewer been identified and located? glYes ❑ No <br /> Have all property storm drainage connections to the side sewer been identified and located? ,il 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 thi 'e can Check BW Grinder pump,etc.): <br /> Where was the device installed (general description, ttttac map)? f� rn f cf4-D ),„ e4-- <br /> Was there any other sewer or storm drainage work completed in conjunction with the BWD work? Is so please describe:_ <br /> _�', <br /> Installation Checklist: <br /> Are all downspouts and site drainage disconnected from upstream of the BWD? Yes ❑ No Comments: <br /> ,z, <br /> Does BWD positioning meets minimum slope requirement of>1%?,'\'es No Comments: <br /> Can BWD be pulled out for inspection and maintenance after loosening thumb screw? ,121 Yes ❑ No <br /> Is BWD locked into the proper position and thumb screw tightened? (es ❑ No <br /> Circle the BWD cover: '.=,•. : r•'- an•scape . -:)I traffic load bearing cover(drive surface)/access hatch(building) <br /> Was property o , - -: - •w ion of the installed BWD? [ 'Yes ❑ No Comments: <br /> Property Owner's Signatur Date: /Z/3///7 <br /> Installer's Signatur, ......... Date: 1 Z/4/ lr <br /> Revision:2 1 Friday,September 12,2014 <br />