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/ . � <br /> �'� � BACKWATER �'REVENTION DEVICE F�INAL <br /> � <br /> E INSTAI.LATION CHECKLIST <br /> �� � j �; � . <br /> lostalla(inn Co�npany Nanie und Contar.t �nto� �l���������-� � �� L �i�1�� -- <br /> 11a1�: Eiacko,ater Prceon!�on dev!�e(Bl'1'D)�vas �nstal!eJ . //'�°�'S--Dale!nis Ic�m�vas comn,eled_ /��`�f i-�_ <br /> b;�,t�lt:ilion PrupeRy Owner Namr and Conta:l In�o c?�!u_ J F-c�Hv'�— �-��� -� JZ�7 .-_2( �-f•ZG5 <br /> � <br /> � . ,�w/!e� � . .___.%I/C'_,�L'� ------ <br /> P�,�perty AAdress ���1�_ ----���.` —-- <br /> Pre•Installation Inspection Checklist: � <br /> �i'�i•em�m:isf he ^hnr.ked 'Ves'm o;dei (o� a l3LVD fc be consioFred for mstailahori ��/ <br /> I:;�hme ;i basemenl or le��a'o�ihe house that is at cr nea�assumed sevrer main elevation?�� Yes i _)t�s <br /> n�c th�re fizWr�s m Ih� hcusc lotaterf b��lav+th,�upslream se,ver rran�cl� rm elevatio��''���s �_���/Np <br /> ��Ih,, sitle sewer eurren;�y UNPROIECTE�from sewer back�(�<. Ir,oes �n� i ;�r•: �i 91��'I; .�:u I�,:J'�% jy!� Y��� i. _' ��:� <br /> Sitr. Inspeclion Checklisl' <br /> �,��;;crr;�r,usf ne ch�cked 'Yes'belore ir�spection is c�ns�derua���cr, �r'^te <br /> Vi a,side sevrer 1�'inspected irom bwiding to sea+ci main? [�J Yes j_� No C �id4ior __ _ _ _ __..__ . __.. <br /> >>r,r. ;Ide ,e+rer ha:�e ai least t°,slope Irom Uie hu iJing to seww ma n� �� Yes �_)N� Dr.s,cr be _______ __ <br /> '!.;:�:a!I buiP.hrg sea�er dr,am conr.ecl�o.ns lo Ihe seie sewer been identif�?^, and located7 ���Yes 1_] No <br /> Navr:all propr.rty slonn tlra'nage conneclions to lhe side sev:er been ident�lied ard located7 LJ Yes �� <br /> Ha� p�ope7;C��cn evE�lualed for dra�nage deficiencias wdh hndinys commun�cated to property ovrner7 � Yas ❑ No <br /> Installalion Delails: <br /> '+`;hat I��u� antl br�md o1 f3WD v,�s in;talled a�lh�s sile Cle�n Chcck HN.�� Gr nder pump �le ) __ ____. _ _ _ <br /> 1'lhe r � s thc �ievi��_� �ns�allu� (gcnc�al dr.sr.npUn ��Itarh mapi _ /A r�� � tx/S� <br /> l�.,sr_ ��o� ,�.�._�.� _c%�_ _��r�._7a. .�r ��1�-- -fi' - �r�-y�.rA <br /> VJ.is !hwc ;nq�olhcr ;r,;,cr ur slorm druinaye work �:ompletod io c;m�urc!�nn�,v�R�the i3N'D v:ork� i� so p'�e2se des� ril�n t(�r�' <br /> Inslallatiun Checklist <br /> l�ic ,i�l du;ar;puut; and s�te drainayc dc��r�nnected from upstrr.am o1 lhe � ��'D"� j� es � -� N'� Cur„r�n,, <br /> li��es f3W1)posdioninu meels mmunu!n slopr.requucmenl ut >1°','? �I ��; � � No C�o uncid�, -_-_ . -- <br /> C�n 13N'D be pulled out loi mspection aiW maintenancr, .tltiar luusr,•uny Ihu h screv.�? ��'J Yes �. �N� <br /> Is DWU locked mto the �ropei pnsihor. and Ihumb screw�tl�aldened? � Ycs �_f No <br /> -��.. <br /> Cude Ihe �VJD cuvor(�unyaGon cover(I�uid,r.ape a�i�,F'ir3(fir,load ar�ng coti�er(Urive surtacr.)�ar,ceas halch (bu�ld:n��) <br /> ';�l�is propeity o�•+ner sho,vn �he location o(Ihc installed 81�!U"� i Ycs �_ ) No Comments. _______ ___ <br /> /� <br /> Piopeity O:�rnei's S.�qnature _ �;,�`-�.•�—`- -- Dale --/�14��---- -- . <br /> Install��r'SSig�atwu . �--_l!'� �,r•�� - --_. _.__. — �— Dat9 ��ZU�/,� --- -- <br /> /.� <br /> Hrv�tiion 7 1 lvinnil,aY, Srpt��mbur ]S, 1014 <br /> 's. <br />