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BACKWATER PREVENTION DEVICE FINAL <br />INSTALLATION CHECKLIST <br />Installation Company Name and Contact Info: • � 'tu��t�-'� <br />Date Back�vater Preven6on device (84VD) was insfalled: 4-�- Date this form was completed: s� %� � 5 <br />Instalfation Prooedy Owner Name and Cont�ct Info: U� c-��-��`��' ✓ <br />PropertyAddress: �,'!'S'� � v.�s ,a�e E��•rc14 ��P 9h��� <br />Pre•Installation Inspection Checklist: <br />All items must be checked 'Yes' in order for a BWD to be considered for installation <br />Is there a basement or le�,�el of lhe house that is ai or near assumed se�.ver main eievation? � Yes ❑ No <br />Are there fixtures in the house located belotiv the upstream seH�er marhole rim elevalion? � Yes ❑ No <br />Is the side sewer currently UNPROTECTED from sewer bac!cups (doss not have a BWD inslalled)7 Q Yes ❑ No <br />Site Inspectlon Checklist: <br />All items must be checked 'Yes' befor� inspecticn is considered ccmp!:te <br />Was side sewer N inspected from building to seH�er main? �j Yes ❑ No Condition: <br />Does side sewer have at least 1% slope from the building to sewer main? � Yes ❑ No Desc�ibe: <br />Have aIl buiitling se�ver drain connec5ons to the side see�er been identified and located? �1] Yes ❑ No <br />Have afl propeRy storm drainage connections to the side se�ti�er been identified and located7 Q( Yes ❑ No <br />Has property been evaluated for d2inage defciencies �viM 6ndings communicated to property o�vner7 d Yes ❑ No <br />__ __� <br />Instailation Details: <br />What type and 6rand of BIND was installed at this site lean Check Bt� .'�rinder pump, efc.): <br />�Nhere vras the device instailed (general description, attach map)? ��c " � r � � - �� �'�� ' '� � �` <br />VVas lhere any other sevaer or storm drainage work completed in conjunction with the B�ND e�ork? Is so please descdbe: _ <br />Instaliation Checklist: <br />Are all downspouts and site drainage dlsconneeted from upstream oi the BWDT � Yes ❑ No Comments: <br />Does BIND positioning meels minimum slope requirement o(>t °�o? � Yes ❑ No Comments: _ <br />Can BIND be pulled out tor inspection and maintenance after loosening thumb screw7 � Yes LJ No <br />Is BWD locked into the proper position an�t mb screw tghtened9 � Yes ❑ No <br />Circle the BWD cover. �irrigatio cover (landscape area)! ffic load bearing cover (drive surface)1 access hatch (building) <br />Was property owner sho�m the'focation�i-4he-inst3l ed BVJD1 �Yes ❑ No Comments: <br />Property Owners Signature: Date: <br />Insfallers Slgnature: � Date: 5' �`�� <br />Revislon: 2 `= / 1 Friday, September 12, 2014 <br />