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�� Backwater Prevention Device <br /> .� � Property Owner 62ebate Form <br /> Please verify the following items: <br /> �� the owner of the property served by the side sewer where lhe Backwater <br /> Prevention Device was installed. <br /> � I w rked with my coniractar to determine the installalion location for the Backwater <br /> Prevention Device, I understand that the final decision regarding irstallation location <br /> wasimine. <br /> If the Backtivater Prevention Device was installed on my property: <br /> • I have 6een shown how to access, inspect, and maintain my device by my <br /> . contraclor <br /> • I understand the City will nol maintain the Dackwater Prevention Device. I <br /> am exclusively responsible to mainlain il and to keep it in good working <br /> ordec <br /> • If I sell my property, I tviU make the huyer aware of the Backwater <br /> Prevenlion Device and thc need to maintain it. <br /> Choos •one of the following; <br /> As oF now, my property has no downspouts or olher onsile drainage that connecls to <br /> the side se�ver upstream of the instalied Backwater Prevention Device. <br /> or : <br /> ❑ I still have downspouts or olher onsile drainage Ihat conner.ls to lhe side sewer <br /> upstr,eam of the installed t3acM�vater Prevention Device. I understand ihal leaving these <br /> connections,means that the risk of flooding (rom downspout or onsi!e c'rainage remains. <br /> I accept that risk. <br /> Sir�nature�..f� �-- Date 7-j�l� <br /> � <br /> Page 2 of 2 <br /> Revisr.':I 09/U912014 <br />