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BACKWATER PREVENTION DEVICE FINAL <br /> 4v„. INSTALLATION CHECKLIST <br /> • , <br /> Installation Company Name and Contact Info: A 4 p(tolai Ytj ttc <br /> Date Backwater Prevention device(BWD)was installedc—ita--1 Date this form was completed: <br /> Installation Property Owner Name and Contact Info:obi, wetta,b <br /> , , A • <br /> Property Address: Ig 6 t 6e,w4 f\vg --61„i ,ax-- -1, .-v-i. <br /> Pre-Installation Inspection Checklist: <br /> All items must be checked Yes'in order fora BIND to be considered for installation <br /> Is there a basement or level of the house that is at or near assumed sewer main elevation?t3<0 N. <br /> Are there fixtures in the house located below the upstream sewer manhole rim elevation?14.)re-s:0 No <br /> Is the side sewer currently UNPROTECTED from sewer backups(does not have a BWD installed)?Prel 0 No <br /> Site Inspection Checklist: <br /> All items must be checked'Yes'before inspection is considered complete <br /> Was side sewer TV inspected from building to sewer main? EPtee-s Ej No Condition: biz-- <br /> Does side sewer have at least 1%slope from the building to sewer main? rtes Milo Describe: <br /> Have all building sewer drain connections to the side sewer been identified and located? P're'S 0 No it; ct <br /> Have all property storm drainage connections to the side sewer been identified and located? Pres E No <br /> Has property been evaluated for drainage deficiencies with findings communicated to property owner? leres 0 No <br /> Installation Details: <br /> What type and brand of BIND was installed at this sit• (Clean Check: . tinder pump,etc.): 014.0.),....(kali_ .. <br /> Where was the device installed(general description,attac map? <br /> Fes-5 7- 63-11,4 r7C- ea):42-4,41 VYN-tArte.- 1,- 444. <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 and site drainage disconnected from upstream of the BWD? .1: 1‘lijNo Comments: <br /> Does BWD positioning meets minimum slope requirement of>1%? WS' 0 No Comment: <br /> Can BWD be pulled out for inspection and maintenance after loosening thu ,„smb crew?. Wes 0 No <br /> 2(..,,,„ <br /> Is BWD locked into the proper position an. i at s rew tighterted? 1es n No <br /> Circle the BWD cover;irrigation co or(landsca.e are. traffic load bearing cover(drive surface)I access hatch(building) <br /> Was property owner shown t - ace. s,O the i -led BWD? [211 0 No Comments: <br /> Property Owner's Si.,.i - , k) <br /> Date: S-- lb <br /> Installer's Signatu,- flt Date: G --915--- t <br /> Revision:2 1. Friday,September 12,2014 <br />