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1 <br /> BACKWATER PREVENTION DEVICE FINAL � <br /> INSTALLATION CHECKLIST <br /> / ; <br /> Installation Company Name and Contacl Info _�-�YI UI✓1 af � C �-S� �I 8 5 -o �Z� ' <br /> Date Back;rater Prevenlion device(BWD)�vas inslalled: �a(e Ihi orm was e�mpleled: <br /> Installation Property Owner Name and Conlac� In(o: �7�L1 �"ti--- __�C�_ <br /> Pro ert Address �-}�� � ��'�'�����'1'ZT � <br /> P Y �-�.—L-!u"�.I-- � <br /> Pre-Installation Inspection Checklist: <br /> !�?7 ifems must he checked'Yes'in order ior a BWD fo be consrdered for installafion <br /> Is there a basement or level oi the housc Ihat is al or near assumed sewer main elevalion? C es ❑No � <br /> Are lhere fizlures in the house localed belrne Ihr,upsireai�i se�ver manhol�rim elevalio�7 C�❑No <br /> t;the side scv;er currently UNPROTECTED irom se�ver backups(does not have a B4ND ins4�lled�? [�es ❑No ' <br /> Site Inspection Checklist; <br /> All ifems must be r,hecF:ed'Yes'Ceiore inspection is consrdeied complete <br /> t1'as side se�ver N inspecled irom building lo sewer mainl [(]1`•��No Condilion:� <br /> Does side sewer have al leasl 190 slope from lhe building lo sewer main? [-�� No Describc: <br /> I lave all huilding sewer drain connections to the side sewer been idenlified and located? rjr�e5 ❑ No <br /> Have all propedy storm drainage r.onnedions to the side sewer been idenhfed and loealed? [j�a'cfi ❑No <br /> Has property been evalualed (or drainage deficiencies wilh findings communicated lo property o�,vner? (-_ ts '� I No <br /> Installation Oetails: <br /> 1Mhal type and hrantl of BWD vras inslailed at Ihis sil (Clean Gher.k l�dV,Grinder pump,elc): __��C�- C-��G� <br /> 1^lhere was Ihe device installed(general descr ion; atla ap .. <br /> �< <., a - <br /> �'Jas Ihere any other sewer or slorm drainage work co p�letl in conjunclion��ith ihe 84VD work? Is so please cescribe:_ <br /> - -- --- �L�� � - <br /> Installation Checkllst: <br /> Are all dovrnspou�s and site drainage disconner,led (rom upslream of the 8WD? ��U No Cnmrnenls: <br /> Ducs BWD posilioning meets minimum slope requirement of>1%? es []No Comments: ___ <br /> Can BVVD he pulled oul(or inspeclion and maintenance afler loosening thumb screw? �s ❑No <br /> Is BWD tor,ked inlo Ihe praper position and Ihumh screw tighlened? �j�.l`�Q No <br /> Circle lhe BN�D covcr. irrigation �er(landscape a 1 Iraffic load bearing cover(drive surtace)I access hatch (huilding) <br /> :�:�as property nwner shown the lo� n o(Ihe � Iled BN'D? es ❑ No Commenls: __— <br /> % � � <br /> Proper�y 0rrner's Signaturej _ Dale'��G� � , <br /> Instailer's Signalure • -��- Date. ��'� � <br /> Revision: 7, 1 Friday,September 12, 2014 <br />