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BACKWATER VALVE INSPECTION <br /> a . CHECKLIST <br /> Property.Address: 1"10 5 13An+-J 5+ <br /> BWV inspected by: LALLA-a- 0adcu( Date BWV was Inspected: : ( ! $ ( ( S f e�r <br /> 2 <br /> _i ec-k inase.rn?M`+ x�-wr e `J u Ni `o- cL2.1) �'Yn <br /> l}eq.S1•n\C 100.5 no 6raiv+c - C � ssc..1. 1b-de-Li) <br /> Inspection Checklist <br /> Are all downspouts and site drainage disconnected from upstream of the BWV? ❑Yes ❑ No <br /> Comments: iJ0 r / fperiLs <br /> Does BWV positioning meets minimum slope requirement of>1%? ❑ Yes ❑ No <br /> Comments: <br /> Can BWV be accessed for inspection and maintenance? ❑ Yes ❑ No <br /> Can BWV be secured into the proper position? ❑Yes ❑ No <br /> Where is the valve installed (general description, attach map)? <br /> Is the installed BWV considered an 'approved' model by the City of Everett? ❑Yes ❑ No <br /> Was property owner shown how to inspect and maintain their BWV? ❑Yes ❑ No <br /> Does this BWV require repair or replacement? gYes ❑ No deeds <br /> Comments: 1-(eis c. 5ttp put.von Wr/2.. r) bac cle t i' eed5 -/b <br /> Y'4ip A y A view crr ,_ Attlee( -kJ Fs(i4- OJwv►.e,r ' 5 C-41I0 <br /> Inspectors Signature: Date: $l 15` <br /> Revision: 2 Thursday,January 08,2015 <br />