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�a . <br /> I3ACKWATER PREV�NTION DEVICE FINAL <br /> INSTALLATI(iN CHECKLIST <br /> Installalion Company Name and Contact Info: CeA'1'�'�PPJ�5 PWd 'Al� � (NC <br /> Dale Backwater Prevention device(BWD)was installed:I`��_Dale this form was completed:_(�,�j t� <br /> Installation Property Owner Name and Contact In(a_��L�.{�n Q� <br /> Properfy Address: l � O�L A C,�l�Q��' Un4 q�j,�L_ <br /> Pre•Installation Inspection Checklist: <br /> All items musf 6o checked'Yes'!n�rderfora BWD to be considered lorinsfelletion <br /> Is lhere a basement or level ol the house that is at or near assumed sewer main etevation9�s ❑No <br /> Are lhere fixtures in ihe house located below the upstream sewer manhole rim elevation7 'es ❑No <br /> Is the side sewer currenlly UNPROTECTED from sewer backups(does not have a 8WD installed)7 Yes ❑No <br /> Site Inspection Checkllst: <br /> All items must he checked'Yes'belore Inspection Is considered cromple <br /> Was side sewer N inspecl°�1 irom building to sewer main? es ❑ No Condition: FP�► (Z. <br /> Docs side sewer have at least 1%slope from the building to sewar main? 'es ❑ No Describe:_ <br /> Have all buildina sewer drain connections to the side sewer been idenlified and located7 Yes ❑No <br /> Have all properly stortn drainaye connecffons to the side sewer been identified and located7 [�'�s ❑ No <br /> Has property beon evaluated for drainage daficiencies with findings communlcaled to property owner7 �s ❑No <br /> Installation Details; <br /> What lype and brand o!BWD was installed�t this site(Clean Check BWV, Grinder pump, elc.): CL�A� C�tf+f�e1L <br /> Where was Ihe device installed(general descnption,aft3ch map)7 Vl�llO A"T1�r_r1�b1� <br /> Was there any olher sewer or storm drainage work completed in conjunction with lhe BWD workT Is so please describe yjQ <br /> Installation Checkliat: <br /> Are all downspouts and site draina��e disconnected from upstream ol Ihe BWD? es ❑ No Commenls: <br /> Does BWD posilioning meets minin�um slopu requirement of>1°h7 ' es ❑No Comments: ' <br /> Can E3WD be pulled oul for inspection and maintenance after loosening lhumb sc,ew? es ❑No <br /> Is BWD locked into lhe proper position and thumb screw tightened7 es ❑ No <br /> Clrcle Ihe BWD cover: irriyalion cover(landscape aroa)I lraKc load boaring cover(drive surface)I access hatch(building) <br /> Was pioperty owner sliown ihe location ol tlia instslled BVJD7 _ es [-, No Commenls: <br /> Property Owner's Signalure:_ __ Date:_�a�"�'/'� <br /> inslallers Siynature: Date: �Z��_ <br /> Itevision: 2 1 Monday,September 15, 2014 <br />