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BACF(WATER PREVENTION DEVICE FINAL <br /> E„ � INSTALLATION CHECk(LIST <br /> „ . 1'►'l�ri ccc:'1 �,�� � G "F `5+d� SC.cz�'�'l L L_G <br /> Installation Company Name and Conlact Info:S�.�•� 1{i C(?(�,`�'�'� -������n�< �`K,):��I �'���;,Z <br /> Date Back�vater Prevenlion device (8WD)v�as installed: ��`�a �l-f Date Ihis form �vas completed: <br /> Installalion Proper�y OwnerName and Contact info: 1�lLViG� � �[�77+'�/t-I i-(.Q ���.i��i __ - <br /> Properly Address: o�� �-3 f�l�(��.`CF:�.u'�f 4��1/-� ���� I/1/�— ci' Oo��1 <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 level of the house thai is at or near assumed sewer main elevation? �'es ❑ No <br /> Are there fixtures in the house located belov�the upstream sevaer manhole rim elevation?�Yes ❑ No <br /> Is the sid2 sr.v�er curre�tly UNPROTECTED irom sewer backups(does not have a BWD inslalled)? (�Yes ❑No <br /> Site Inspection Checkiist: <br /> All items must be checked'Yes'before inspection is considered complete <br /> N�as side sewer TV inspected irom building lo sewer mainl �Yes ❑ No Condition:��JjZ�____ <br /> Does side sewer have at least 1"/o slope irom the huilding to sewer main? �'Yes ❑ No Describe: <br /> Have all building sewer drain conneclions to the side sewer been idenlified and located? �Yes ❑ No <br /> Flave all property slorm drainage conneclions to lhe sitle sewer been idenlilied and Iocated7 �'es ❑ No <br /> Has property been evaluated for drainage deficiencies v;ith fndings communicated to property owner? [�-Yes ❑No <br /> Installation Details: C� �� <br /> Whai type and brand ot BWD a�as inslalleJ at this site(Clean Check BWV, Grinder pump,elc.): �� ��i" <br /> Vt�here was ihc devir.c instalied(general desr.riplion, atla�h rnap)'? _����r'"D"�� .S I� � <br /> VJas Ihere any other sewer cr slonn drainage work cnmpleted in conjunr,lion wilh Ihr, EiWD woric? Is so please descri6e:_ <br /> -- — -- — - — -- - --�c��'1Q --- <br /> Installation Checklist: <br /> Are all downspouts and sile drainage disconnecletl from upsiream of the BWD7 ,�'es L�No Commenls:____ <br /> Ones BWD positianing meeis minimum slope requirement of>1%? �Yes �_� No Comments:. <br /> Can BWD he pulled oul for insper,tinn and maintenan�e af�er looseniny thum�screw? �es ❑ No <br /> Is DVJD locked inio the proper ��ilion and thum6 screw tightenetl? �es ❑ No <br /> Cirde Ihe BWD covcr. irrigalion cover(I���ape area) I traftic loatl bearing cover(tlrive surfar.e)I access hatch(huildmg) <br /> �__- <br /> Was properiy o�rmer sho�m the localion of Ihe instaVed BWD? �Yes ❑ No Commenls:__ ___ <br /> � <br /> Property Ovmer's Signalure:_ � _?���_ ��a��'ti-- Dale: ? ^�� � � <br /> Inslaller's Signa(we:�J ___ _ __ Date:�2= Lz- �5 . <br /> Hevition: 7 1 f'riday,Septr.mber 12, 701A <br />