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47.7 .7. BACKWATER PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> Installation Company Name and Contact Info: /9-74- PI-r -?LI yl q LLC' <br /> Date Backwater Prevention device (BWD) was installed: to-/ 7—/S' Date this form was completed: (a—/ <br /> Installation Property Owner Name and Contact Inf : <br /> Property Address: 7:2—I . 6171A Co-4 <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 that is at or near assumed sewer main elevation? n No <br /> Are there fixtures in the house located below the upstream sewer manhole rim elevation? M-Y-es ❑ No • <br /> Is the side sewer currently UNPROTECTED from sewer backups (does not have a BWD installed)? 0 Yes ❑ No <br /> Site Inspection Checklist: <br /> All items must be checked Yes'before inspection is considered complete <br /> Was side sewer TV inspected from building to sewer main? -❑ No Condition: ('k a <br /> Does side sewer have at least 1%slope from the building to sewer main? mss- C No Describe: <br /> Have all building sewer drain connections to the side sewer been identified and located? ❑ygs-C No <br /> Have all property storm drainage connections to the side sewer been identified and located? 1 Y_es- ❑No <br /> Has property been evaluated for drainage deficiencies with findings communicated to property owner? es n No <br /> Installation Details: S <br /> What type and brand of BWD was installed at this site _ , Grinder pump, etc.):ES C - <br /> Where was the device installed (general description, attach map)? LQ L PPLA4V L( <br /> Was there any other sewer or storm drainage oo k completed in conjunction with the BW work? Is so please describe: <br /> l <br /> Installation Checklist: <br /> Are all downspouts and site drainage disconnected from upstream of the BWD? [-tis ❑ No Comments: <br /> Does BWD positioning meets minimum slope requirement of>1%? (des C No Comments: <br /> Can BWD be pulled out for inspection and maintenance after loosening thumb screw? Et-Yes ❑ No <br /> Is BWD locked into the proper positio .1• ,__,;•: -- : , tightened? des n No <br /> Circle the BWD cover: irrigation cs er(landscape area)/ :ffic load bearing cover(drive surface) /access hatch (building) <br /> Was property owner shown the locaf e installed BWD? ❑ No Comments: <br /> Property Owner's Sig woe Date: 6-f-7-1 e <br /> Installer's Signature: Q11)1--- <br /> Date: 6-(7 - <br /> Revision: <br /> 2 1 Friday,September 12, 2014 <br />