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BACKWATER PRE-Vr---T90N DEVOCE HN <br /> AL <br /> ENSTALLAT90N C `-CKUST <br /> 112VInn <br /> Company name and contact Inf6- <br /> D21e Backwater Prevention device(BIAID)was -7(-C) <br /> i installed: tl- <br /> Date th <br /> Property Owner Name and cContact 'E;form Was Completed: <br /> installation PrO <br /> Info, <br /> PrOPOrtY Address: /amu, I <br /> All items n7ust he checked'Yes,in <br /> order fora Bl4/D to be Mnsidered I-or installaiiDn <br /> Is than a basement or <br /> 16VOI Ofthe house that is <br /> Are there 11-tures in at Or near assumed sewer main eleMilon? <br /> Yes Ll No <br /> the house located below the upstream sewer manhole rim elavatlan7[Z Yes EjNo <br /> Is the side sewer currr--,nt�UNPROTECTED;torn sewer backups(does no,. <br /> Site ln-specVon P L have BAJD inSialled)? yes D Flo & <br /> All Mems must be checked--yes, <br /> before inspection is considered <br /> cam late <br /> Was Ride sGwer TV inspecte I d from building to sekqer main? <br /> Doesside Sewer have at least 1%slope tOm the buildiYes No Condition:Se—1 <br /> ng 5e'Vur main? <br /> ------------ <br /> H,9VG all building sewer drain connections to the-side sewer10 been identifiyes ❑ <br /> No Describe:6nd located? Yes r-1 K10 <br /> Have all PrOPe*storm drainage Connections tO the side saw <br /> gr been ident riled and located? <br /> Has properbl been evaluated;or drainage deficiencies with findings communicated to properly El Yes NO <br /> owner? <br /> in'SAE-[la-don Details.. <br /> What type and brand of BWD was installed at this site(Clean Check <br /> BW1, Grinder pump, Gtc,).. <br /> Where'Alas the device installed(general deacripuon, attach map <br /> )? <br /> Was there any other sewer 01-storm drainage work <br /> completed in conjunction with the BW D v�ork? Is so Please describe: <br /> Are all downspouts and site drainage disconnected from upstream of the,Bk/VD? No Comments: <br /> Does BIND positioning meets minimum slope requirement of>1%? MyeS <br /> Qt for 111SPecUon and maintenance Can BWD b:'Pulled OL COMMenls,- <br /> n2nce afteF 100sening thumb screw. ENO <br /> Is BVVD locked into the proper position and thurnbscrew tightened? ELYea—ETM6- <br /> Circle the MAJD cover: ateff-m <br /> _jmg ver(landscape area)I traffic load bearing cover(drive surface) access hatch(building) <br /> Was prcpprty owner shown the location of the instailed BVVD? y5s EDNO Comments, <br /> ProPefty Owner's Signature: <br /> Date, <br /> InStallses Signature: <br /> Date: <br /> Revision.2 <br /> P&ndaV,September 15,2014 <br />