1307 E MARINE VIEW DR 2018-03-09

BACKWATER PREVENTION DEVICE FINAL diebt4C"--A INSTALLATION CHECKLIST Installation Company Name and Contact Info: CA w\ rO aLt`a PL t<)i 4 P im(-) , 1,\_)‘ . Date Backwater Prevention device (BWD)was installed: 7--1/;--/7 Date this form was completed: ~"-//-—7-5-- Installation Property Owner Name and Contact Info: ,i-L Pr 7 - Property Address: & - . -e4 ' Pre-Installation Inspection Checklist: All items must be checked Yes'in order for a BWD to be considered for installation 3 Is there a basement or level of the house that is at or near assumed sewer main elevation? /Yes Cj No Are there fixtures in the house located below the upstream sewer manhole rim elevation? 17 Yes C Nc , Is the side sewer currently UNPROTECTED from sewer backups (does not have a BWD installed)? ,"Yes C No Site Inspection Checklist: I All items must be checked 'Yes'before inspection is considered c.' ;Mete i Was side sewer TV inspected from building to sewer main? V Yes C No Condition: Does side sewer have at least 1% slope from the building to sewer main? ErYes n No Dribe: Have all building sewer drain connections to the side sewer been identified and located? 'Yes L No Have all property storm drainage connections to the side s.ewer been identified and located? Q"Yes C No Has property been evaluated for drainage deficiencies with findings communicated to property owner? E'Yes C No Installation Details: What type and brand of BWD was installed at this 'e(Clean Check BWV,Grinder pump, etc,): <'' /4, (i .# c Where was the device installed (general descripti n, attach map)? e ✓-i-- ! (1,---“f ii-t Was there any other sewer or storm drainage work completed in conjunction with the BWD work? Is so please describe:1\rC Installation Checklist: Are all downspouts and site drainage disconnected from upstream of the D? 11 Yes (— No Comments: Does BWD positioning meets minimum slope requirement of>1%? n'Yes [l No Comments: i Can BWD be pulled out for inspection and maintenance after loosening thumb screw? Yes C❑ No Is BWD locked into the proper position and thumb screw tightened'? DYes [ No Circle the BWD cover irrig.n ~ I `cape area)/traffic load bearing cover(drive surface)I access hatch(building) Was property owner shown the location of the installed BWD? Yes I I No Comments: 1 Property Owner's Signature: Or ,."edg,, ' — -------- Date —// /Y Installer's Signature; ,� ,n -4- Date: €;:),, J`I I _/I% Revision:2 1 Monday,September 15,2014 1 i 1