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BACKWATER PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> Instailalion Company Name and Contact Info: r9-i9- ,�������b�r� �( c r Qz�- 4 8 g-o�Z-3 <br /> Date Backwater Prevention device(BWD)was instailed: 3- i Z-� S� Date this form was comp!eted: `�- � �- l 5 <br /> Inslallation Property O�vner Name and Contacl In(o: ����ti.o�-r.l F wk. <br /> PropertyAddress: 1-�O l O��GS r9�.•*`— ��* �� � -�' <br /> Pr�lnstallation Inspection Checklist: <br /> All items must 6e checked'Yes'in order(or a 8WD to 6e considered for insfallation <br /> Is there a basement or level of ihe house that(s at or near assumed sewer main elevalion? es ❑No <br /> Are lher�fixlures in the house lorated below fhe upsUeam sew�er manhole rim elevationl es ❑ No <br /> Is the side sewer currenlly UNPROTECTED from sewer beckups(does not have a BVJD installed)?�es ❑No <br /> Site Inspection Checklist <br /> AIf items must be checked'Yes'be%re inspec6on is considered complete <br /> Was side sewer N inspected from building lo sewer main7 Ly�res ❑ No CondiGon: (SYL\�i v���+ e�sr d`l� <br /> c <br /> Does side setver have at least 1%siope from the building to sewer m�in? �s ❑No Descrioe: <br /> Have all buitding se���er drain connections to the side se�ver been idenlifed and located? � � No <br /> Have all property a,�rtn drainage connections to the side se�.rer been identified and located? � es ❑ No <br /> Nas property been evaluated for dr2inage deficiencies with findings communicated to property owne(? es ❑ No <br /> Installation Details: � <br /> l4�ha1 type and brand of BWD was inslalled at ihis sil . nS.11eckElh446nnder pump, ete.): � o '� c� �+-��cLc.�eL <br /> Where was the device installed(general description,attach map)? �Cttief.� a-�1 <br /> Was lhere any other se�ver or stortn drainage�vork co pletetl in conjunclion�vith ihe Bl4'U wori�?Is so please describe:_ <br /> ,�0 N�- . — <br /> Installa6on Checklist: <br /> hre all downspouts and site drainage disconnecled fmm upsUeam of the 8WD7 es ❑No Commenis: <br /> Does BWD positioning meets minimum slope requiremenl of>1%? es ❑No Comments: <br /> Can BWU be pulled out for inspecGon and maintenz�;ce after loosening ihumb screw? [�]'fes ❑No <br /> Is BWD locked into lhE proper posifion and ihumb screw tightened? No <br /> Circ�e lhe B1'VO cove;:irtigation cover(landscape area)�ra(fic load bearing cover(drive suriace)�access hatch(building) <br /> Was property otivnar shown the locafion of the installed BWD? � es ❑No Comments: <br /> c <br /> � � —if <br /> Property Owne�s 5ignaiure: � - Dale: 3 � <br /> Installers Signature: � - /n� Date: ��1�-�� r _ <br /> Revlsion: 2 1 Friday,September 12,2014 <br />