1802 CEDAR ST 2016-01-01 MF Import

i I BACKWAT�R PREVENTION DEVICE FINAL � INSTALLATION CHECKLIST ' ; . � Ins�allation Company Name and Contact Inio� PLvw� Date Backwater Prevenl�on device(BWD)was installed: � Z- I'S Dale this form was completed:�Z - /$_ i )— � Inslalla6on Property Owner Name and Contact Info �--YN:✓ ��ti G� %ffdZ �'�-n,..� s r ' Property Address: f'�'�'��% �^'�` rf'za% I I Pre•Installation Inspection Checklist: � AU dems musf be checked'Ves'in order for a BWD fo be considered fo�installaGon Is there a basement or level of the house lhal is at or near assumed sewer main elevation?�Yes �'Jo ; A�e there f�tures in the house located Gelow the upstream sewer ma�hole rim elevation? [�Yes ❑ No ; Is the side sewer currently UNPROTECTEU from sewer backups (does riot have a BWD ins�alled)7�`j Yes ❑No ; Site Inspection Checklist: I All items must be checked'Yes'before inspection is considered comolefa I Was side sewer"V inspected hom building to sewe�main? �Yes ❑ No Condition: � K j Does side sewer have at least 1%slope from the tailding to sewer main? �Yes ❑ No Describe ; Have all building sewer drai�connections to the side sdwer been identfied and Irated? �Q Yes ❑No � Have all property storm drainage connedions to Ihe side sewer oeen identified and located? bC1Yes [] No � I Has property been evaluated for drainage deficiencies vti�h Gndings commun�cated to properiy owne�? (�Yes [�No ; InstallationDetalls: _-- -. �f-' � i What type and brand o(BWD was installed at ihis sit�ean Che k BWV,Grinder pump, etc.) ('�i��' �� •ti V Where was the devi�e insl�lled (general desc�iptio�, atlach map)? _T'� /�9 5�- ne�-�..1- /--L..+.c.L, � i V�'as ihere any other sewer or storm drainage work completed in wn�unction wiih the 8WD work? Is so please descnbo: _ �v . Instailation Checklist� � Are all do�vnspouls and site drainage disconnecled from upstream of ihe dWD? �Yes ❑No Comments I Does BIND positioning meets mirimum slope requirement of>1"/e? �Yes ❑No Comments _ � Can BWO be pulled ou;for inspeclion and maintenance afler loosening thumb screwl �Yes ❑No � Is BWO IocKed into ihe proper position and thumb screw tigMened? ��es ❑ Na � Circie the BIND covr.c irrigation cover(landscape area)I tralfic load beanng cover(dnve surtace)I access hatch(buildingl N'as property owner shown the location of the installed BWD1 (�Yes ❑No Commenls: ; i Property Owner's Signature: '''7'4n' K'`� Dale ��'�y��J ` ' InstallePs Signalure: � � 7 Dale: �� —�� - �C— � � Revisinn� ) 1 Tucsday,Septemher lf,, )014 ;