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BACKWATER PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLI�T <br /> Instaliation Company Name and Contact Infa �Af� 0��0 Pl�,�4�1Cv 11� <br /> Date Backwater Prevention device(BWD)was installed: L O I � Dale ihis form�vas completed:�� <br /> Installaiion Property Owner Name and Contact Info: �d-�' ��, ��'n �5�� <br /> Property Address: '�l o(�� Q ti� ��-°-� �� <br /> Prednstallation Inspection ChecklisL• <br /> All ifems must 6e checked'Yes'in order for a BWD to be considered for installation <br /> Is there a basement or level of the t:ouse:hat is al or near assumed sewer main elevation7 [�Yes ❑No <br /> Are lhere fixlures in the house located belos�the upstream sewer manhole rim elevation7[�Yes ❑No <br /> Is the side sewer currenUy UNPROTECTED from sev�er backups(does not have a BWD installed)?0 Yes ❑No <br /> Site Inspection Che:kiist: <br /> All items musf be checked'Yes'before inspection is considered compfete <br /> Was side sewer N inspected from building to se�cer main? [�J Yes ❑ No Condition: <br /> Does side se�ti�er have at least 1°�6 slope from the building to sewer main7 [�Yes ❑ No Describe: <br /> Have all building sewerdrain connections to the side sewer been fdenfified and located? �Yes ❑ No <br /> Have all properfy storm drainage connections to the side sewer been identified and located7 �Yes ❑ No <br /> Has properfy been evalueted inr drainage deficiencies wilh findings crommunicated to property owner7 Q Yes �]No <br /> Installation Details: - , <br /> 1Nhat type and 6rand of 81ND was inslalled at ihis sit (Clean Check BNN rinder pump,etc.): <br /> VJhere�+�as ih:;uevice installed(general descriplion,attach map)? ��c�� ��—��nvc�-s!��-P'� `�`�"'�P <br /> Was there any oiher se�ver or slorn�drainage vrork completed in coijunetion with the BN'D erork?Is so please describe:_ <br /> !'��/) <br /> Installation Che�klist: <br /> Are ali downspouts and site drainage disconnected from upstream of the BWD1 [��Yzs ❑ No Comments: <br /> Does BWD positioning meets minimum slope requiremenl of>1%7 �Yes ❑No Commen!s: <br /> Can 8WD be pulled out for inspection and maintenance after loosening ihumb screw? [7i Yes ❑No <br /> Is BWD locked into lhe pr9per positi�ndihemtrscr>ew�ightened? �Yes ❑No <br /> Circle the BWD cover irrigation cof_ ver(IandscaQe�rea)1 traffic load bearing cover(drive surface)I access hatch(building) <br /> Was property owner shown the Iocationgf-t�e installed B� [7�Yes ❑No Commenis: <br /> Property O�vners Signature: l� /i�n J + �L7�=���� Date: `���'/�`��� <br /> Instailers Signature:_ � Date: y�?��—� rS <br /> Revision:2 1 friday,September 12,2014 <br />