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tl <br /> BACKWATER PREVENTMN DEME FINAL <br /> TMN CHEECKUST <br /> ALLA/ <br /> lnstafj@ffC,n CoMPEDY Name and contact info: Moe <br /> Date Backwater Prevention device(qvt,D)was jnSt@jjd. L(__ -7(�C) <br /> completed: V—6 <br /> Installaiion Pro peq Owner Name and Contact info: Date this form vdas <br /> PrOPerty Address, C -e r <br /> Q 7 76 5- Vc.Y-) <br /> pre-Irl'91t:a1lation fri0pecuou checklist: <br /> All items must b-- <br /> chec;jced 7es"n order for 8 BWD to be considered zorinstallatio <br /> Is there a basement or jE;Vej 0 the house that is <br /> n <br /> L <br /> at or near assumed sewer M in el on? <br /> Are there fiXtures in the hOLISO located below the ups, ve a evat! 91 Yes Ll No <br /> Ire <br /> Is the side sealer currontly UNPROTECTED from am sewer manhole i"M 010vatOn?E Yes 0 No <br /> m sewer backups(does not have a 13�;VjD <br /> site InspeDtIort ohecm-i'-t; installed)? M yes Flo <br /> All fterns must be chocked ryes, <br /> before inspection is considereil corn 1, <br /> Was side sewer T11 inspected from <br /> building to selt%ter main? yes <br /> Does side sewer have at least I%Slope from the 0 Yes <br /> diflt on: 0 kbuilding jQ 5%vur main? El No Describe: <br /> H2O ad building sewer drain connections to the side sewer been ideniffiedand located? ' <br /> Have all PFOPU�L storm drainage conriec�ons to the Side sewer been identifil ed and l &�Yes ONo <br /> Has Property been evaluated for drainage deficiencies With f ndings communicated to cared? El Yes El No property owner? Ej Yes j\)o <br /> What type and-brand Of BWDwag installed atthis site(Clean CheckMAJV, Grinderump, <br /> Where was the device installed(general deac;r1pdon, pattach map)? <br /> Was there any other <br /> sewer OF storm drainage work completed <br /> 'fl conjunction with the BVVD work? Is so Please describe: <br /> d Checklist: <br /> or <br /> Gh <br /> Are all downspouts and site drainage disconnected from uWMarn of the BVVD? Efyes E:j No Comments: <br /> Doss BIND positioning meets minimum Slop requireMent 0,>I%? <br /> Yes []No <br /> Can BVVD be Pulled OWL fOFinspection and maintenance after loosening thumb screw <br /> Is 8VVD locked into the proper position and thumb screw tightened? <br /> Flo <br /> Circle the KAID cover: irrigation cover(landscape area)I traffic load bearing cover(drive surface I <br /> jq .q 5 �' : wilding)) <br /> VI/26 property owner shown the location of the installed EVVID? M Ye's El F10 Comments <br /> Property Owner's Signature, <br /> Date, <br /> Installer's Signature: c>:;�_ Date: <br /> Revision:2 <br /> MOMAV,September 15,2024 <br />