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s <br /> BACKWATER PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST , <br /> i <br /> Installation Company Name and Contact Info: 41141 4 u a n e L L L, 421 t L 6/r 7 3 <br /> Date Backwater Prevention device(BWD)was installed: 3---13 � I; this form was completed: c5 ( 81 S <br /> Installation Property Owner Name and Contact Info: it.:.. .uLa," „�Fc ,1 <br /> Property Address: \ �_ <br /> p Y �- � � r� T ' c`7 `�tfrz- l )--A4--- <br /> Pre-InstallationInspection 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? es n No <br /> Are there fixtures in the house located below the upstream sewer manhole rim elevation? es No <br /> Is the side sewer currently UNPROTECTED from sewer backups(does not have a BWD installed)? (q. lets ❑ No <br /> ( <br /> Site Inspection Checklist: <br /> All items must be checked 'Yes'before inspection is considered complete �� E <br /> Was side sewer TV inspected from building to sewer main? EL E No Condition: - Z (0("C 811-- - <br /> Does side sewer have at least 1%slope from the building to sewer main? [mss 0 No Describe: _ <br /> Have all building sewer drain connections to the side sewer been identified and located? P- ❑No <br /> Have all property storm drainage connections to the side sewer been identified and located? es E No <br /> Has property been evaluated for drainage deficiencies with findings communicated to property owner? g-Yes ❑No <br /> Installation Details: <br /> What type and brand of BWD was installed at this site(Clean Check BWV, Grinder pump, etc.): 6/Lek-eta— <br /> Where <br /> was the device installed (general description, attach map)? 4--/-/ ' F- ., ill <br /> /,j Gr .17 _(7 ; - `7_ //07-7714Ft.a Gt <br /> Was there any other sewer or storm drainage work completed in conjunction with the BWD work? Is so please describe: <br /> Installation Checklist: <br /> Are all downspouts arid site drainage disconnected from upstream of the BWD? 1 s n No Comments: L - . <br /> Does BWD positioning meets minimum slope requirement of>1%? es n No Comments: ' .r ,t_s •` <br /> Can BWD be pulled out for inspection and maintenance after loosening thumb screw? [1f 5 ❑No i <br /> Is BWD locked into the proper position and thumb screw tightened? [Ues n No <br /> Circle the BWD cover: irrigation cover(landscape area) traffic load bearingco drive surface)/access hatch (building) <br /> Was property owner shown the location o`the installed BWD? es ❑ No Comments: <br /> y • <br /> Property Owner's Si •_ . . -1 Date: _ 8-In <br /> a <br /> - 1- c <br /> Installer's Signat -: X�` ) Date: n-- ZS <br /> Revision: 2 1 Friday,September 12, 2014 <br />