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= 1 � r �e rr � �- 1 <br />��,.b <br />, � i_ � � <br />��M� <br />{nstallation C�m�any f�ame and Contaet Info: <br />� ( �. . ��' <br />Dat� Backwater Prevention de�ice (BWD) was installed: `"��� �"i �� Dat� th�is form was com�l�te�: II�'� "�� �` :��--� z <br />Installation Properky Owner Name and Contact Info: .� � �`" �' �� � w� � <br />, <br />�� <br />ProperkyAddress: '�� � �'"--- � iz�...���.�:�..�'Y��=. '�„-i�.- <br />Pre-ln�tallation Inspection Checklisk: <br />Alt i%ms musf b� checked `Yes' in order for a BWD io be consider�d far insfailation <br />Is th�re a basement or level of tE�e hous� that is at or n�ar assumed sew�r main elevation7 es � No <br />Are there f�tur�s in ths house located belaw th� upsfream sewer manhole rim �levation? es ❑ No <br />Is the side sewar curr�ntly UNPRt�TECTED fram sewer backups {does no# have a BWD installed)? s❑ No <br />Site tnsp�ction Checklist: <br />Atl it�ms rrrusf be checked 'Yes' before inspection rs car�sideced complef� c� <br />VVa� side s�wer TV ins e�ct�d fr�m baildin ta s�w�r main? es [� No C�ndifii�n: � .�.�� _..% �-e���- �£:` <br />P 9 ----�- �..x ,� _ <br />Docs side sewer have at I�ast �°14 slope firam the building to sewer main? es ❑�!o Describ�. <br />Have �l! building s�wer drain conn�ctions to the sid� sewer been itlenfified and l�cated? �`��s � No <br />Have a11 property storm drainag� cannectians to the side �ewer been identified and located? �� ❑ No <br />Nas prope�ty �een evaltaated fior drainage deficiencies with fndings communieated to property own�r'? [�.,��s ❑ No <br />Insl;aliati�n Det�ils:: <br />What type and brand ofi BWD was installed at this site (Cl�an Check BWV, Grint�er pump, etc.): � �� ��� <br />Wher� was 1he devic� installed {generak description, attach map)? _--- ���.. �`�.. �f� <br />Was there any other sewer or storm drainage work completed in conjunct'son with the BWD work? Is so please describe: _ <br />Instaii��ion Ch�cklis�: <br />Are �Il downspouts and sik� drainage disconnected fram ups#ream af the �WD? ❑ No Comm�nts. <br />po�s BWD p�sitianing meets minimum slope requirement of >1 °JQ? [�.'�e�s ❑ No Comments: .,_ <br />Can BWD be pulled aut fvr insp�ction and maint�nanc� a�ter loosening thumb screw'? �`�s ❑ No <br />ls BWD locked into the proper pasitian and thumb scr�w tightened? �Y-�s ❑ No � <br />Circic fhe BWD cav�r: irrig�tion cover �landscape a�ea)/ traffic load bearing cover rive surfacej ! ac s hatch (building} <br />Was pro�rerty owner shown the lflcafion of the installed BWD'? �� l�s" ❑ N�a o n s: � �`�,� <br />� <br />Properiy qwner's Signature: � .``� .�- Date: "���'� � ``_ � � <br />Dat�: � �_�C� �-� • <br />Installer's Signature: �....�� ' <br />f�evision: 2 1 Friday, September 12, 2p14 <br />