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BACKWATER PREVENTION DEVICE FINAL <br /> T INSTALLATION CHECKLIST <br /> Installation Ccmpany Name and Conlacl Info: t� , � I �� �^ r` ��J __ <br /> D a t e B a c k�v a l e r P r e v e n G o n d e v i c e(B W D)v i a s I n s t a'��d: i a" �> � Date this form was completed:�� - <br /> Installation Property Gwcer Name and Contact Info: C ' / �L�'� �` ' ��` � <br /> PropertyAddress:_�.��1� �-� ������ — <br /> Pre•Installatfon Inspection Checklist: <br /> NI items must be checked'Yes'in order(or a BWD to 6e wnsidered for installa6on <br /> Is there a basemenl or I?vel of lhe house that Is at or near assumed sewer main elevation9��Yes ❑No <br /> Are there fiztures in the house located below the upstream sewer manhole rim elevation?[�Yes ❑No <br /> Is the side sewer currenUy UNPROTECTED from sewer backups(do�s not have a BWD Instaited)1�]Yes ❑No <br /> Site Inspeetion Checklist: <br /> All ifems must be checiced'Yes'before inspection is considered complete <br /> Was side sower N inspectetl irom building to sewer main? [�Yes ❑ No Condifion: <br /> Does side sewer have at least t%slope irom the building to sewer main7 �Yes �No Describe: <br /> Havo all building sewer drain connections to the side sewer heen Identified a d localed? �Yes ❑No <br /> Have all property slorm drainage connections to Ihe side sev�er been ideNified and localed? �Yes ❑ No <br /> Has propedy been e��aluated tor dra�nage defciencies vrilh findings communicated to property o�vner7 �Yes ❑ IJo <br /> Installation Detaiis: �__ __-- - <br /> Whal type and brand o(BVJD was installed at ih' s� ite(Clean Check BWV,Grinddrp�ump,etc.): — <br /> 9--� Y��,..�1=-� 1���� , '�•-C' ; <br /> Where was Ihe device installed(yeneral descriptio , a�maP�• <br /> �x l�.� c �'�,P� — <br /> Was lhere any other sewer or storm drainage�•+ork cgmpleted in conjunction wilh the BWD work? Is so piease describe:_ <br /> �__' ( � <br /> InsL�llation Che�klist: <br /> Are all downspouls and site dralnage disconner.l� ��n upsheam o(the dWD? �]Yes ❑No Comments:___ <br /> Does BWD positioning mee�minimum slope requ iemonl oht%? � Yes ❑No Comments:____.-- <br /> Can BWD be pulled out for Inspection and mainlenancQ after loosening thumb scre�v? �Yes ❑No <br /> Is BWD locked inlo the pro osilion and tlwm65�re�v tightened? []]Yes ❑No <br /> Cirde the BWD cove�_rrigaUon cover(landscape area)1 lra ic load bearing cover(drive sur(ace)1 access hateh(building) <br /> Was propedy owner shown Ihe location ot the installed BWD? [�]Yes ❑ No Comments: <br /> Property Owner s Signature: �--- __ Date: __ — <br /> Inslaller's Signature: � _' Date: l� " �U� -� <br /> Revision:2 ] friday,Sep[em6er 12,2014 <br />