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� <br />� <br />BACKWATER PREVENTION DEVICE FINAL <br />INSTALLATION CHECKLIST <br />Installa9an Company Name and Contact Info: �, <br />pate Backwater Pr+evention device (BWD) was insta <br />Date this lortn was campleted: � S <br />Instatlation Pmperly Owner Name and Contact Info: ��✓��� �'""`- - <br />Property Address: � � � � � 2 �� <br />Pre�lnatallation InspeeNon Cheeklist <br />All rtems musi be diecked 'Yes' in oNer for a BWD to 6e consldered for installafion <br />Is there a basement or level of the house Ihat is at or near assumed sewer main elevation7 [l�Nc�s ❑ No <br />Are there fixfures in the house located bebw the upstream sewer manhole rim eievation? [�fes ❑ No <br />Is the side sewer currenUy UNPROTECTED from sewer backups (does not have a BWD installed)7 [(�Yes ❑ No <br />5ite Inspection Checklist: <br />Afi items must be checked 'Ves' befo2 inspedion is considered mmplete <br />Was side sewer N inspecled from building to sewer mainT es ❑ No Condi�on: �L c''�. �'e� <br />Does side sewer have at least 195 slope from the building to sewer main9 [I�� 0 No Descrihe. <br />Have all building sewer drain connections to the side sewer Deen idenlfied and bcated? [�-Yes ❑ No <br />Have all pmperty srorm draina9e connections to the side sewer been identified and located? [(]Yes ❑ No <br />Has property been evaluated for drainage deficienaes with findings communicated to property owne�t [�� ❑ No <br />Inshllation Detalls: <br />What type and brand of BWD was installed at this sile (Clean Check BWV, Grinder pump, etc.�: � ��� `l"�— <br />Where was the device installed (general description, attach map)7 ��� %'>'�- �"'P • <br />Was there any olher sewer or storm drainage work cumpleled in conjunction with the BWD worlc? Is so please describe: _ <br />h-1� he v— <br />Insqllation Checklist: <br />Are all downspouts and site drainage disconnected from upstream af the BWD? es ❑ No Comments: <br />Does BWD positioning meets minimum slope requirement of >19b? Q.Yes ❑ No Commenls: <br />Can BWD be pulled out for inspection and maintenance after loosening thumb sc�ew7 (f�`es ❑ No <br />is BWD locked into the proper pasition and fhumb saew tightened? __� a <br />Cir�le lhe BWD oover. irtigation cover (landsca�pe area) / ific bad bearing cover (drive s ace)1 access hatch (building) <br />Was property owner shown the location of the instailed BWD? No Commenls: I� C ����� <br />Instaliers <br />Date: �c,� � Z o � i — <br />�ate: �ZT — 5—�- aZ-1— <br />Revision: 2 1 Friday. September 12, 2014 <br />