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BACKWATER PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> Inslallalion Coinpany Name and Contact Info: � DvI I ����''^� �•�G <br /> Date Backwater Prevention device(DWD)vaas installed: �- � -�S Date this form was completed:7— � -�. <br /> InstailaGon Proper!y Owner Name and Contacl info:_..,��W1C���� �'t-��t`�MSo✓1 ' <br /> Property Address: �S� � ' ``�- S�' <br /> Pre-installation Inspection Checklist: <br /> Aff items niust be checked'Yes'in order for a BWD to be considered for installation <br /> Is there a basemenl or level of lhe house that is at or near assumed sewer main elevation9[�Yes ❑No <br /> Are there fi�ures in the house located below the upstream sev�er manhole rim elevation7[�J Yes ❑No. <br /> Is ihe side sevaer currently U�PP.OTECTED irom sewer backups (does not have a BWD installed)?[�Yes ❑ No <br /> Site Inspection Checklist: - <br /> Alf items musf 6e checked'Yes'before inspecfion is cansidered complete <br /> VJas side sewer N inspecled from building lo sewer main? [�Yes ❑ No CondiBon: <br /> Does side sewer have at!east 1%slope from the building to sewer main7 [�]Yes ❑No Describe: <br /> Have all building sewzr drain conneclions to the side se�ver been fdentifed and located? [�]Yes ❑ No <br /> Have all property storm drainage connecfions to 1he side sewer been idenCfied and located? �]Yes ❑No <br /> lias property been evalua�°d for drainage deficiencies�viih findings communicaled to property owner7 [�]Yes ❑ No <br /> installation Details: � <br /> lNhat t�Pe and brand ot BWD was inslalled at this sil C eal n Checr— k BNN�inder pump,elc.): <br /> VJhere was lhe device inslalled(general descnrtion,ariach map)? �.,c�t-�( �� '� '( `'�'�� <br /> ��S <br /> Was lhere any olher sewer or storm drainage v�ork completetl in conjunclion v�ith ihe BWD v�ork? Is so please describe:_ <br /> A� � — <br /> Installabon Checklist: • <br /> Are all downspouts and site drainage disconnecled from upstream of Ihe BWD7 �Yes ❑ No Comments: <br /> Does BWD positioning meets minimum slope requirementoi>1%? (�Yes ❑ No Commenis: <br /> Can BWD be pulled oul for inspecllon and mainlenance after loosening thumh screv�7 �Yes ❑ No <br /> Is BWD locked into tlie proper�osilioa-an�thum�scre�v fighlened? �]Yes ❑ No <br /> Circle the BWD cQv�mg 6 cover landscape�rga)�Uaffic load bearing cover(drive surface)1 access hatch(building) <br /> Was property ovmer sho�m ihe localion of the inslalled BWD7 �]Yes 0 No Comments: <br /> Property O�vner's Signalure:_ Dale:. � <br /> Inslallers Signaiure: --- Date:� • � � �� <br /> Revision: 2 � 1 Friday,Septembcr 12,2014 <br />