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004p.../ . BACKWATER PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> Installation Company Name and Contact Info: 1414 p( tivo'llo""i kk-c, -4W-- 41 9 7-1512-3 <br /> ira <br /> Date Backwater Prevention device(BWD)was installed: 1 0'I H ate this form was completed: (ZZ-t? <br /> iP * <br /> Installation Property Owner Name.and Contact Info: - _0 - OtAr -._.- A' 1 .0 P. ' <br /> Property Address: . 9 r9- that <br /> Pre.Installation Inspection-Checklist <br /> All items must be checked'Yes'in order fore 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?[0-Yes 0 No <br /> Are there fixtures in the house located below the upstream sewer manhole rim elevation?[ Pres Ej No <br /> is the side sewer currently UNPROTECTED from sewer backups(does not have a BWD installed)?Ellre; 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? Defes1 No Condition: ii/eA0 <br /> Does side sewer have at least 1%slope fmm the building to sewer main? [21e-S7 1:1 No Describe: <br /> Have all building sewer drain connections to the side sewer been identified and located? ID-Yet C No <br /> Have all property storm drainage connections to the side sewer been identified and located? 0.-Yese-0 No <br /> Has property been evaluated for drainage deficiencies with findings communicated to property owner? 0.4er 0 No <br /> Installation Details: <br /> What type and brand of BWD was installed at this site(Clean Check BWV,Grinder pump,etc. : .β€ž.. ,....,., .,...e... - <br /> Where was the device installed(general description)attach map)? IAβ€” A...dight. i, 1 ''. if' <br /> . β€” <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 /> PK-. <br /> Am all downspouts and site drainage disconnected from upstream of the BWD? es El No Comments: <br /> Does BWD positioning meets minimum slope requirement of>1%? 5:1X(S---0 No Comments: <br /> Can BWD be pulled out for inspection and maintenance after loosening thumb screw? Prei 0 No <br /> Is.BWD locked into the proper position and ti._,.,..-w tightened? EPrir0 No <br /> Circle the BWD cover:irrigation ce er(landscape ar-. traffic load bearing cover(drive surface)/access hatch(building) <br /> Was property owner shown the location of the installed BWD? El-Yet0 No Comments: <br /> Property Owners Signatue;,406,,,,, Date: 112----1;'m 17 <br /> trr7, <br /> Installer's Signature: Date: I-1.,-- <br /> Revision:2 1 Friday,September 12,2014 <br />