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--- ------____-_-- --- ---:__- -_-=_ <br /> �--_-=--__ _ - ---- - - _--- --- - <br /> ' / BACKWATER PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> fI�S�Y'� � ,�CRI�'� 0.{'1C CC,J�t'.��— <br /> I�stal at�cn Com;acy IJarre a�c Conlact 1�10. ,�CJ� N�US � L/��I3' — <br /> Jate Bar.k�va�r,r Prevertio�dewce (BVdD)was irstalleC � '�����5 Dale Ih s `orm�szs corra'eled _ ^ �"" %� <br /> I�stafa!io� Proprrty0er�erNar�candContacl n(r�✓�sl�w3 ,�'���/��'P I�S� �3Cr ��� <br /> Pro eh Address. _ � � (. �K�%'� � � -- ---- — <br /> p v ,��fl.---�_ ��S-__�_ - <br /> Pre-Installation Inspection Checklist: <br /> A'f dems rrw�t be checkea Ves�ir order for a AV✓D fo be ransidered for installatrr,n <br /> Is there a basemem cr levol o`the house tha;is at c•�ear ass�med se�ti�er ma�� clevat:,�?I�'Yes � ) No <br /> Are there f�xicres in Ine house lo�aled he ow t^e upstrea�'scwer marhole rin� e,evatic���Ycs ^^ No <br /> Is Ihe side sa:+e•c,urro��ly UNPROTEGTED hom se�rer b2-kcps(does not have a BWD nslalied�����Yes U N� <br /> Sitc Inspection Cheeklist: � <br /> !JI dems nrus�be cner.ke� Yes before iaspection is cors�cr:red complefe I! <br /> 4"das side se�:�cr TV irspr.r,�r.d`rom b�llr.ing to sewer ma c? �Yes ',^ t�o Cordi•or __ <br /> Dces sitl2 serrer haee a; east 196 s'cpe from the b�iid rig;�se��,er nain? � Yes � No Descn x, <br /> Have all bu lding se�ver A•a,n correclions to;he siAe sewer been identified and lo�a!ed7 � Yes ,_ No <br /> Nave all aroperty slu�m drainage conner,tions to Ihe side se,ver heen eien;i5ed a�d I„cater,'� �! Ye:c � � No <br /> -!as prcpe .ry br.r.� eva ::a'ed fo�dra�nage de(ic�encies�v';h findngs �oT�mcnicated to :�•c�erty a•.�e�� �!Yes n No , <br /> I <br /> Installation Details: ` ' <br /> 4"Jhat;y�pe anc hranA n`8'A�D was inslalled at ihis sAe Glean Chec BWV, Gnnder�ur�p,elc ) ���G�U��'�c./ <br /> YJhere era� thr. ;!e��ire �mtalled (genera'd�scrption,attach rrap)� ��7�• ���'�� �� o�r�, ——.- <br /> __ -- — - -- <br /> VJis there any rnhe sewer or sto m drainage work co ��pleled in conjuncbor a�ilh Ihe BWD %�ork'�IS so ple,asF desr.nbe� _ <br /> — . ��._ — — — — - _—� <br /> Installation ChecklisL <br /> Aie -a'I dr.N�i�pouis and si;e draicage disr,unnecled Irom ups�rc��m ol ihe Ei11'D? ��'�'s � � N� Co^�n�enls - -- <br /> i <br /> D�x�; BVJD �>>�;�nn ng mr.els �nm�mum slope requ��remenl r,f >1°.�'� '�Yes ❑ No Comments . _ ' <br /> C,+n BVJD Le pul'rd out fnr'�nspeclion and ma nlenancr, aNer loosenmg'h�mb screvil �Yes � � No <br /> s BWD lor.ked into thc proper�ws tion a�d Ih�mb scrr.v;tiyfitened? � Ycs � �No <br /> Orcie the BWD cover. irnga!�o^ cover(landscapc area 11r�d(�c�oad be.iri .iiavu�drive sur'ace;1 ac�;ess ha,ch (buiidtng) <br /> VJas property oe�ner show�Ihr. tor,ation of Ihr. �nstalted E3N'U� �Yes � , No Comments: _ _ __` <br /> Property Owrer's Signa'u e ` v / V _ / ' Date � �Iv - "+'�ls --- - <br /> InstaVcr's SignaL,re _j� � } u UC1t'�;,.�L� Datc: � '—/�`aU� ---- <br /> �-, <br /> Rrv�s ��n ; 1 Fnd,�Y. S�plambe� 17. J014 <br />