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. <br /> �. <br /> ��,, BACKWATER PREVENTION DEVICE FINAL <br /> IRISTALLATION CHECKLIST <br /> Inslallalion Company Name antl Contact Info: SEATTLe oRaiN sERvice _ <br /> Dale Backe�ater Prevention device(BWD)was installed:_ Date lhis form was completed: _ <br /> Installalion Property Ovmer Name and Contact Info: �EFF RICHTER <br /> PropertyAddress: 340B LOMBARD EVERETT WA 98207 <br /> Pre•Installation Inspe�tion Checklist: <br /> All items musf 6e checked'Yes'in order for a BWD fo be considered lor installation <br /> Is there a basement or level of ihe house that is a!or near assumed se�ver main elevation7��s dJo <br /> Are there fixtures in ihe house located below the upstream sev�er manhole rim elevatio � afe n No � <br /> Is the side sea�er currently UNPROTECTED from sewer backups (does noi have a BWD i�nstaile�es� No <br /> Site Inspectian Checklist: <br /> All items must 6e checked'Yes 6elore inspection is considered complete <br /> Was side se�ver TV inspected(rom building to sewer mai u Yes o Condition: <br /> Does side sewer have at least 1% slope from tlie building to sevrer me ? a Yes t No D ibe: <br /> Have all building sevaer drain connections lo the side sewer been identified and locat ? CKe ii �do <br /> Have all properly slorm drainage c�nnections to the sitle sevaer been identified and located n Yes � No <br /> Has property been evalualed for drainage deficiencies with findings ccmmunicated to property owner. o Yes I No <br /> ti Installation Details: �I_ n1��� <br /> What type and brand of BWD a�as installed at this site(Clean Check BWV, Grinder pump, etc.): 1C�ev� L.1 ��, <br /> Where was the device inslalled(general descriplion, atlach map)? �L�:c��_�_ <br /> Was there any olher sewer or storm drainage work compleletl in conjunction tivilh the BWD work? Is so please describe: <br /> --�---- <br /> Installation Checklist: <br /> Are all downspouts and site drainage disconnected from upstream of re 8WD? i es o Comments: _.___ <br /> Does 8WD posilioning mee�s minimum slope requirement o(>1%? I es �o Camments:_ <br /> Can BWD be pulletl oul (or inspeclion and maintenance afler loosening thumb screw?�LYes �tVo <br /> Is BWD locked into the rope asiha�r�screw tightened? o Yes_o No <br /> Circle the BWD cover: i«igation cover landscape area) tra(fc load bearing cover(drive suriace) I access hatch (building) <br /> Was property ovmer sho�m t e location ot the inslalled BWD?n Yes I I No Comments: <br /> � Property O�mers Signature; ��''� � Date: �— � <br /> � Installer's Signature: �N � Gate� % � � � � <br /> Revision: 2 � 1 Monday, Seplember 15, 2014 <br />