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BACKWATER PREVENTION DEVICE FINAL <br />d INS �TALLATION CFiEGKLIST <br />�'u'f`i Can `��r� c� � � � <br />Instsllation Company Name and Contacl !nio�..1���" j� i�i; -� ��� yr -�� � <br />Date Back�a�ater Predention device (BUVD) was installed: d ��r�_ Date ihis form tivas completed: � S <br />Installation Property O���r�er Name and Contact In(o: �,� L� L 7-�-� d� x a i4��=��� c x"��._-_ <br />Properiy Address: <br />Pre-Installation Ir._� _ - <br />Afl ifems must be checked'Yes' i. � oroe� for a BV✓D to be considered for insfallal on <br />Is there a basement or level of the house ±hat is at or near assumed sewer main elevation� Yes ❑ Plo <br />Are there fixWres in the I�ouea located betow the upstream sewer manhoie rim elevation? Yes ❑ Nu <br />Is the side setver currenNy UNPROTECTED irom sewer backups (does not have a BWD installetl)� Yes ❑ No <br />Site Inspection Clieck!�st: <br />All items must be checked 'Yes' before inspectinn is considered complete �� <br />Was side se.var TV in�pected from 6uilding to sev�er main? �Yes ❑ No Condition' <br />Does side sewer have at least 1% slope from the building to sewer main? (1��fes ❑ No Describe: _ <br />Have all building sewer drain conneclions to the side setver 6een ioeNified and located? � Yes ❑ No <br />Have all property storm drainage conneclions to the side sewer been identified and located? � Yes ❑ No <br />Has property been evaluated for drainage daficiencies e�ilh fndings communicated to property o, �ner? �'Yes ❑ No <br />Installation Oeiails: C� <br />What type and brand of BV1'D �vas inslalled at this siie (Clean Check BWV, Grinder pump, etc.): � ��'.� <br />Where v�as the device installed (general tlescrip(ion, atta�h map)? SP.P �.�(> %r.F��� 9C� S�1.i (,� <br />Was there any other sewer or sterm drainage �vorl: corip!eled in conjunction ti^rith ihe BWD work? Is so please desr.ribe: _ <br />Ihstallation Che�klist: <br />P.re all doivnspouls and sile tlrainage disconnected from upstream of lhe DWD? �Nes ❑ No Commenfs: <br />�oes BWD posi;ioning meets minimum slope requiremenl of>1%? �Yes ❑ No Commenls� __, <br />Ca�i BWD be pulled ou? for inspection and mainlenance after loosening thumb scre�v? �'es ❑ No <br />Is BWD locked into the proper posilion and ihumb screw tightened?�'Yes ❑ No <br />Circle the BWD cover:}R a(ion cover endscape area) I tra(fic load bearing cover (drive suriace) I access hatch (building) <br />� ~`— � <br />Was property o�merstrot�riine location of thejas alled BWD. ��'es ❑ Nc Cemments: <br />� � <br />Property Owner's <br />Instalier's Signalure: <br />Wt�c?,75 Date:_ z� �> <br />—`=--t;`L`t.�T <br />� �� Date: � � _ <br />� <br />ReviSion: 2 � 1 Friday, Sepeem6er 12, 2014 <br />