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� <br /> I <br /> � �ACKWAYER PREVENTION DEVICE F[NAL ; <br /> a, INSTALLATION CHECKLIST � <br /> f <br /> 1 �ri c�tin �p �� �r s� �c.�t�'� � '-4. i <br /> Installation Company Name and Contact Inio:.S�Ce ' �� �-' � '� ' .S� '% ' ' � `�;� <br /> Dale Backwater Pre��ention device(BNlD)e�as installetl:���.,�Date this form e+as complefed: �f' � <br /> !nstailation Property O�vner Name and Contact Info:�� VYl 7 C K J�� �tc�S " 3�sS=����_ � <br /> q �.�� f� l�c"r� G'r �'�� 1 � <br /> Property Address: , <br /> Pre•Installation Inspection Checklist: <br /> All rtems must 6e checked'Yes'in order for a Bl4�D to be considered for installation <br /> Is there e basement or level of Ihe house thal is at or near assumed sewer main elevation�es ❑ No i <br /> Are there fixWres iri the house localed belov.the upslream sewer manhole rim elevation7 es ❑ No { <br /> Is the side sewer currenUy UNPROTECTED irom sea�er backups(does not have a BWD instalted)?�fes ❑ Uo i <br /> Site Inspection Checklist: � <br /> f <br /> Ali il�ms must be checked'Yes'be(ore inspection is considered complete / i <br /> YJas side sev+er TV inspecled from building to se�ver main? {�1'es ❑ No Condition: ��C¢ ; <br /> Does side sewer have at least 1%slope irom the huilding to sewer main? �Yes ❑No Describe: � <br /> Have�II buildiny sewer drain eonnections to the side se�aer been identi6ed and loeated7 (�'es ❑No � <br /> Have all property storm drainaye conneclions to the side sewer been identihed and located? �es ❑ No f <br /> Nas property been evalualed for drainage deficiencies with findings communicated to property �vner? �Yes ❑No ' <br /> Installation Details: /� � <br /> lrJhat type and brand o(BWD was installed at lhis sile(Gean Check BINV, Grinder pump,etc.): �� ,��/Y � <br /> �1� .�'�C-�.� , <br /> lh�here was Ihe device installed(general descriplion,aVach ma �:�—C�� j <br /> — ! <br /> Was there any other sewer or slortn drainage work comp!eted in conjun�tion with the�WD v�ork7 Is so please describe:_ i <br /> dYLC � <br /> Installation Checklist: � I <br /> Are all downspouts antl sile drainage disconnected from upstream of the BWD? ,�'es ❑!Jo Comments: i <br /> Ooes BWD positianing meels minimum slope requiremenl o(>i%? �Yes �_]No Comrnents: _ ! <br /> Can BWD be pulled out(or inspection and maintenance after loosening lhumb scre�v9 [�1'es ❑No � <br /> Is BIND locked into lhe pro�er Qosition and thumb screw tightened? �es ❑No � <br /> Circle the BWD c er.irrigation cover pa Uscape area) I traffic load bearing cover(drive surface)1 access halch (builtling} ; <br /> Was property owner shown the IocaGon of the inslalled BWD? �fes ❑ No Commenis: <br /> Property Owner's Signalure: rW�2�� Dafe:_(� I� � <br /> Installers Signature: �� —�� Date: � <br /> Revision:2 1 Friday, Sepiem6er 12,2014 � <br /> t <br /> i <br />