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'or471 BACKWATER PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> Installation Company Name and Contact Info: SEATTLE DRAIN SERVICE <br /> Date Backwater Prevention device(BWD)was installed: 1 _-4 C?`-1 f Date this form was completed: V)-Zo--19-' <br /> Installation Property Owner Name and Contact Info: KAY SHELLER 425-355-2704 <br /> Property Address: 2015 RUCKER 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 f, <br /> Is there a basement or level of the house that is,at or near assumed sewer main elevation? Yes alo <br /> Are there fixtures in the house located below the upstream sewer manhole rim elevation?,[es 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. es ddo Condition: 0 ewes- C— r 75 <br /> Does side sewer have at least 1% slope from the bu i ding to sewer mem.k�(Yes I I No Describe: <br /> Have all building sewer drain connections to the side sewer been identified andlocated? ies }i No <br /> Have all property storm drainage connections to the side sewer been identified and locatedes o No <br /> Has property been evaluated for drainage deficiencies with findings ccmmunicated to property ownef Yes I I No <br /> Installation Details: <br /> What type and brand of BWD was installed at this site(Clean Check BWV,Grinder pump,etc:): )•efr+A C'i I <br /> Where was the device installed(general description,attach map)? C1s .� �n � rr�` �r --`�`' <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 to BWD? i 45: o Comments: <br /> Does BWD positioning meets minimum slope requirement of>1%?4 a No Comments: <br /> Can BWD be pulled out for inspection and maintenance after loosening thumb screw? re No <br /> Is BWD locked into the proper position and umb screw tightened. • " No <br /> Circle the BWD cover:irrigation cover(landscape area) I traffic load bearing cover(drive surface) I access hatch(building) <br /> Was property owner shown the location of e installed BWD? el No Comments: <br /> Property Owner's Signature:V )di-141-8.14_2 Date: 1,; / 7/ I <br /> InstalIes Signature Q _. 6 Date: <br /> Revision:2 1 Monday, September 15,2014 <br />