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BACKWATER PREVENTION DEVICE FINAL <br />INSTALLATION CHECKLIST <br />Installation Company Name antl Contact In`o: !� P�:% ,�'1�_� >.� � <br />�ate Backwater PrevenGon device (BWD) was installed: .��-t �� Date this tomt was tompieted:,1��i�iS' <br />Installation Propetty Owner Name and Contact InFo: �� ,�� G�2//e r7G' �' br�� <br />Properly Addiess: {��. �f c�i i� Y <br />Pre-Installatfon Inspection CheckllsL' <br />All ifems must 6e checked'Yes'ln order tora 8WD to be eonsidered (orinstallaUon <br />is fhcre a basement or level of the house that is at or near assumed sev�er main elevation? Q i'�s ❑ No <br />Are there fixlures in the house located belov� the upstream sewer manhole rim elevation7�] Yes [] No <br />Is the side sewer curren0y UNPROTECTED from sewer backups {does nat have a BWD installed)? �/] Yes ❑ No <br />/ <br />SitelnspecHon Checklist: <br />AIJ i�ems musf 6e checked'Yes'be(ore inspeclion is considered complete <br />Was side se�ver T1f i�spected from building to sewer main7 [� Yes ❑ No Condition: <br />Does side sewer fiave al least i%slope Gam the buliding to sewer main7 Yes ❑ No Descnbe: <br />Have all building sewer drain connectlons ta the side sewer been �dentified nd located7 � Yes ❑ No <br />Have all property storm drainage �ronnections lo Ihe side sewer been identified and iocata � Yes ❑ No <br />Has properiy been evaluated for drainage deficiencies with findings communicated to property owne�? � Yes ❑ No <br />Installatlon Detaiis; <br />What type and brand of BWD was instaVed et lhis sita beck87��1 JGrinder pump, etc.); <br />Where was the device insla�led jgenaral descdplion, attach map)? ri�n�� ��J <br />Was Ihere any olher sewer or slortn dralnage �vork crompleted in wnjunction with the BWD work7 Is so please describe: _ <br />Instaliation Checklist; <br />Are all downspouls and site drainage disconnected 1rom upslream uf fhe BWD7 �/J Yes ❑ No Cnmmenls: <br />Does BWD posiUaning meets minimum slope requirement of >1%7 �j Yes ❑ No Commenis: ^ <br />r <br />Can BWD he pulled oul ior irspecfion and maintenance afler loosening thumb screw? � Yes ❑ No <br />Is BWD lo�ked inlo the pmper posit on and thumb scre htened? � Yes ❑ No <br />Gircle the BWD cov imgaUon wver (landscap��affic load beanng wver (drive surface) / access hatch jbuilding} <br />Was propedy owner shown the localio� of <br />Property �wner's <br />InstallePs <br />BWD7 [� Yes ❑ No Comments: <br />.�/�— Date; J /�/ '�S� <br />� � Date: 3 � % /.r <br />Revislon: 2 1 Friday, Septem6er 12, 2014 <br />