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BACKWATER PREVENTIQRI DEVICE �INAL <br />INSTALLATIt�N CHECKLtST <br />InsiaUalion Gamp�ny �rama and Cvntzcl Info: <br />� <br />Date Backwater Prevention dev�ce jBY,mj was inst�lled• � 1��Dafe this torm was complete�.,��_�S <br />Insta�ation Ptoperty Oqwner Name and Contact lnfa. �L:19�"'t-�^-9 '�C�-�'� dY'�- �- ��—' ��� � <br />Pt�erty Address: , 1 d� C c7��-/ J�'�-!� <br />P�ednglallation Inspeadon Checklist: <br />Aii iferr� musl 6e checked'Yes' i� orderfor a BWD io be consrder�d for rnsla!'aJion <br />15 ihere a basemeni ar level oi iite hoase fhat �s al or near assumed sewer ma�n elevation? [}� ❑ No <br />Are Ihere fixlures in ihe house localed below tha upstream sewer manhnia nm efevation7 es ❑ No <br />is ihe side sevrer cunenUy UNPRfliECiED (rom sewer backups [does noi havc a BWp inst�lle�'� I�`c�5 ❑ Na <br />Site Inspe�Non Checklist: <br />Ali items must he checked'Yes' 6eiore inspedian is cvnstder�d camplete . <br />WaS side sawef TV inspeGled irom Guddinr� to sB�vEr main? � Q tJ0 COndi6D�: �t-. C5121�..L`�--� <br />Ooes slde sewer have al least 1�6 sinpe hom the bu�ding 14 se�ver mam? j�-Y€s' I] No besoribe. �J <br />Have all buddmg se�ver drain ronnecGons lo ihe side seµTr been idend�ed and localed7 i� e❑ tdo <br />Havd afi prope�ty srorm dromage mnnect�nns io the sir;e s=wer Geen �dentified �nd loc�ted7 �yj.Yss' [] ho <br />H�s properfy bet+i evaWated for dra�nage doficlencies wth findings communir.al?d In properly w�ner? [t�fcs ❑ No <br />Installation Dc�aiis: <br />UVhal typc and brand ni FiVJD uas instaPcd at lhis silo (Ctean Check QVJV, Grintler pumo, eis_j '� -�� �•�L <br />) <br />Wh�te �va� th� devic� installed {general descnp6on, altach map}7 �__ � Ir'y� h'�-+� <br />Was inere any rlher ssw�er or siorm dra�nac�o <br />tompieietl in con�uncli�n w�h 1he l3WD worh? Is sa �aleas0 descn6e= _, <br />;!�'� �.--�- <br />fnstal(ation GhecktisL• <br />hre all �forrnspoui5 and sit? tlr�a�nar�a tiSconnecled irnm upsl�eam otlhe 6Vu�Cf? �'�� (_,1 Ida Commcni5 <br />IJtres BVi�f.7 pa�•�t+onim� meeis minimum slope mqu�remRnt ot �l'Y�? [��a [] No C�inmenis. � <br />Can 6WD pe pulled ou� rar tnspeci�en and ma�ntenancc alir•r laosening thumb scret�7 y�l� �] (40 <br />Is BP~'� lo�kcd ir.ta the pro�er pnsiGan and ttiurr� screw tightened? �[� k�o <br />Circle ih4 BWO �Uver urigation cover (landscape area) _ a(Bc lo�d hearing c �ve surfacej! access halch (bu�ldingl <br />Wa� pa�perty rnmer sho�vn the location dilhic instalied 13Wt.f? QYLs� f�n Comrnents _ <br />Prope�ty O�vner's <br />tnstai'•ei's S�gnalui <br />ba�e �r -L�i~15 <br />l�atc: �d r�.' �1 _ � � <br />Rr+visioni d 1 �rirlay, S�ptembrr ]2. 2Q74 <br />