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� <br />� <br />BACKWATER PREVE�TION DFVICE FINAL <br />INSTALLATION GHECKLIST <br />I stallation Company Name and Contact <br />ao� <br />n <br />Date Backwater Prevention de��ice (BN�Dj was installed: S- J����� Dafe this form �.vas completed: S��y''���� <br />Inst311ation Properl <br />Propeii�� Address: <br />Pre•Installation Inspection Checklist: <br />All items must be cfiecked'Yes' in order for a Bl4�D to be considered for insfallation <br />Is lhzre a basement or fevel o(the house lhat is at or near assumed setver main eievaiion?" Yes ❑ No <br />Hre there tixlures in the house I�caled below tne upslream sev.rer manhole rim eievation7 [v� Yes ❑�!o <br />Is the side sewer currenUy UNPROTECT@D (rom sev+er hackups (does not have a BWD installetl�? �� Yes ❑ No <br />Site Inspection Checklist: <br />AU items rnus( be checked 'Yes' belore ins ection is considered compiete (- <br />�r�ras side sewer TV inspected trom building to sewer main7 �Yes ❑ No Cordition: ri.vtiCll f <br />Does side sewer have at least 1% slope trom the buifding to se�ver main? � Yes ❑ No Describe: <br />Ha��e all building sev+er draln connections to ihe side se���er been idenlified and localed? 1G,1 Yes ❑ No <br />Ha��e all property storm drainage Connections to the side se��;er been identined and located? �es ❑ No <br />Has property been evalualed for drainage de(iciencies vailh findings communicaled lo property o�:�ner? L�-I�res ❑ No <br />Instalialion Details: <br />1A�hat t, pe and brand of BWD �vas installed al this site Clean Chec BWI�, Grinder pum , etc ): <br />14�here e�as the device instailed (general description, af � aP)� —_��--� <br />1��as thore any other see�er or sform drainage work completed in conjunclion ���ilh ihe BWD work7 Is so pleaso nescribe: <br />Installation Checklist: <br />Are all doemspouls and sife drainage disconnected (rom upstreari� oi th BLND? Yes ❑ No Comments: <br />Does BWD posilioning meets minimum slope requirement of >1 °/a? _ Yes [_� No C nmenls: <br />Can BN'D be pulled out for inspeclion and maintenance after loosening 1 umb screw? 1'es ❑ No <br />Is BWD Iocked into tiie proper position re�v tightene ?[�Yes � No <br />Circle ihe 8WD cover. irrigation covei Q2ndscape area ! traflic loa bearing cover (drive surface) / access halch (buiiding) <br />lA�as pioperty oe�ner sho�vn ihe loca(ion of the inslalled BWD? Yes ❑ No Commenis: <br />Dale: �I'' �o�C7 <br />Property Owner's Signalur � — —' <br />Instailer's Sigi�ature: �� Q�7A� l� �ate: -5 ���� �O/��_ <br />c <br />ftevision: 2 1 Monday, Sr.ptem�er 15, 2074 <br />