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ACKWQTER PREVENTIt)N DEVICE FINAL <br /> 1 �'I 1 T <br /> , <br /> � <br /> Installation Comp�r�y Nar�e and Cpntact Infa � �' ��� �- � <br /> Date Backwater P+�ev�n�on devics(8WD)was instaEled: 'r"� �-�� � ate this form was cx�rnpleted: �-�w-�-�-�,,,��� <br /> .�,�_—�. �`' � <br /> InstaUa�on Pro�erty�+ner Name and Cont�t infa: ��1�'�"°�... f�i.�..-�-�.��,�..�.-: ' <br /> � ��-� l�'`t '" -� . <br /> Prop�r�y Addr�ss: ��°�. � � �_�,� � �� -��-� �����,.� <br /> Pe'�-lnstallatit�n I�spection Checklist: <br /> A1!items must b�checkeaf'Yes'in order for a 84ND tn be ams�'er�dd f�r installafran <br /> Is there a basement or Ievel a€the house that is at or near assumed sew�r main etevation?�� ❑No <br /> Are there fixkures in the house bcated�low the up�eam sewer manhole rim eEeva�an?[��''��'es [7 No <br /> Is the side sewer currently UNPRaTECTED from sewer backupS(does not hav��BWD instatEed)? []Nn <br /> Site In�pection Checkiist. <br /> A!l i�ems mast t�c�e�k�i`Yes'be�ire inspectr�n is oonsrder�d campt�te = <br /> Was side sewer"T"V inspected from building to sewer main? es ❑Na Conditian:, ��. �- � �T <br /> Does side sewer have a#least 1°�6 slape from the buifd�ng to s�wer main? es ❑No C)escribe: <br /> Have all building sewer drain connections to#he sid�sewer�n idenfified and{oc�at�d? � ❑Na <br /> Have all properi�t storm drainage connec�ons to the side sewer been identified and located? �es ❑No � <br /> Has property been evaluated for drainage deficiencies wifh findings communicated ta property owner? [��es ❑No <br /> Instaltation D�taits: � <br /> What}��and brar��of BWD was installed at this sote(Clean Check BWV,,GnncEe�pump,etc.): (� ' �����.-��-��'��... ' <br /> �l}n'" �„ P <br /> Wher�avas fihe device installed(generai description,attach map}? '�� � �' �`�r'�,��`�'�' ` ����� _ �•��-=� <br /> Was there any #h sew,r or storm drainage work mplet�ci in con'uncti�n wit�the BWD work? Is so pfeas�descril�:,^ <br /> t �� �� ���, � <br /> > l ���~ �.�.� � <br /> ln�t�ltation Checkl��� <br /> Ar�all downspauts�nd site dt�ain�ge dis�on�ect�d from upstream o#the�Wa? ' es 0 No Commen#s:�.,_,_ <br /> Dt�s�Ih1D�sifioni�g m��ts minimum sla� ' uir�mm�nt of>1°lo? �� ❑N� Comments: <br /> Gan�WD I�pulled out#oe ins�ti�n and maint�n�nc��fter ioos�ning thumb scre�a? �s� ❑No. <br /> Is 8WD k�ked int�the pr�r posi�on and t��mb s�rew�ghtened? w[�Yes❑�!o _ ` <br /> . ,..w �..:�:�,... <br /> Circle the BWD cov�r.imgafion cover{landscape ar�a) �~ �ic lo��g,r.�u� drive s��faece}���ss hatch(buildin9) <br /> Was property owner shown the loca6on of the installed BWD? es�[)Na Comments: ; <br /> Property flwne�'s Signafi�re: .��-��..�,�-�- Date: �`���~r �°"�� '`,� £: <br /> Inst�ller's Signat�r����'�� Date;„�� ���'� �, � <br /> �..,--- <br /> Revision:2 1 Friday,September 12,�014 <br />