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�AGKV�ATER PREVENTION QEVICE FIN/aL <br /> Ey INSTALL,�TION CHECKLIST <br /> t. <br /> � <br /> (nstallation Company Name and Cont�ct lnfo`�l�js��t����'�������'c+�.iib�y�,�_t=-'t�i��''��; :�`�:?���;'<=� ~ ��/E'�-�.._ � <br /> Date Backwater Prevention device (SWU) U�as ins(�,Il��ci:����f(� f);3Ic Ihi�; fc�rn� w���� r.��n���l��icsi ��� <br /> � _ , , r,i <br /> Ins[allation Property Owner Name and Contaci Inf��:�.��-`��'� j,�-`�� ��z-� � �����1��-� �l�)� <br /> Property Address. �;.�-� ��'�?j�:`'i�l'�`. �;�`�. '� ; <br /> _ __ ---------- _.. ____ . ... _____ ¢ <br /> —--- � <br /> Pre-lnstallation Inspection Checklist: ' <br /> All items must be checked `Yes'in order far a f3WD tv bc:cr�nsidcrc�cl(or�inst��ll��tioiz <br /> Is there a basemenf or leve!of#he house that is af ��r ne��r�assu�rtc<d sewer rn�in r;lt:v�3lioi�`? ����{'�er> (_ � No �� <br /> Are there fixtures in the house located kaefow the upsEr����Y�sew��r manh��l�rim elevation7 � �}''���s � f N�� <br /> Is the side sewer current(y UNPRQTECTED from sewer backups{does r�ot have a E3WD insi�311eci)'? �v�Yc.s (_ ]No <br /> Site lnspection Checklist: <br /> AI!items musf be checked'Yes'before inspection is consrdere�c�rn��lete <br /> Was side sewer TV inspecfed fram building to sewer main? (.,_ Yes [„) No Condilion: __T_.___.__ ' <br /> _ _ ___—______. <br /> Daes side sewer iiave at least 1%slope from the building to St;wer n�ain? (�Ycs � .j Nc� D�sc.rif�e; __ __ <br /> Nave all building sewer drain connecfions to the side sewc:r t�e>c.�n ider�lifi�d and Iocated7 ( t�Yc.s ( � N� <br /> Have aif property storm drainage cannections ta ihe sicie sewer fae�ri idcr�tified and loc�.alesj'? ( �e5 ( _] No � <br /> Has property been evaluate�i for drainage deficienr,ies�f�ilh (indinqs c;ommunicateci fo prc�C�e�1y c�wn{�r'? f ��`Yes O No <br /> lnsfallation Details: <br /> What type and brand of BWQ was instalied af this site(Cle��n Checi< BUVV, Grind�r pun�p, efc.}:�L.-�G�4-_�4_�d�- � <br /> Where was the device installed (generai description, attACll 111�3�)�'1 �-i���_�y.��; .�1_G� ��,;��� <br /> — - ---_ _._. .__ __. ___ s <br /> _ � <br /> 1Nas there any other sewer or storm drainage work compfeled ir�conjunclion with fhe BWD wt�rk? (s 5�>please describe; � <br /> ln�taJ]afion Checklist: <br /> A�re�!I downspouts and site�tlrainage�diseonnectetl from «f��trea�»r�f the BWD? (���Y��S ( � N�a C;«i�ii�x:�nts: <br /> _____ ____...__ ; <br /> � � 9� p q � „ � �� , -- <br /> � <br /> D6es BWD �sitionin meets minimum slo e re �rirei7��nl�1 >�� /�'� �'Y�� � No C;oi��na�;�'��s: _ y � <br /> _._ ._ __- <br /> Can BWD be ��ull��:d au(fc�r inspection and mainlenr�ncc���f(c�-I��os��i�i�ag thumt�scrE�;w'?� � �' �Ycs � ( Nu <br /> Is BWD I�ckecl into ti�e pr�per position a� -ia�unf�Sr,rew ii��hi�;nc.d? (_�'S'es � __� No <br /> Circle the E3WD r,over: irrigatian e er(landsca���'iy I(�affic,lo�d l�`��ring cover(drive s�irf��cc�}I,�r,a���s l�;tich (i�uil�liiir�j <br /> , <br /> Was ��ro�crly own��r sl�own the I � �f��� mst<�Il��i [3WC)' ( � c�s � j No C��m+nt��+ils ; <br /> ��� � � <br /> Propr�rty (h�tm�;r',; ,`;i��n��lure�_ ,, - ----�— L `__� - . + _._____ (�),�1��: � '" �_`�' �� � � <br /> � <br /> ; } JJ >> � <br /> �I1Sitil:�� �; ;�>���Il���ul_�`. > • , f)��I�'' �����I �� � <br /> __��. __ C <br /> _ ,_ �� _._. .---- <br /> Rc'G"�,!�ril: .' I fVli�iuti,,y, '�����f��tul��•i 1`�, .'f11-�! <br />