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BACKWATER PREVEN710N DEVICE FINAL
<br /> �. „ INSTALLAYION CHECKLIST
<br /> In_tallaTon Cortp<,oy Nan�: ar�i Con?a�t Ir`o /�i�.-//c� j��l,�ir�l n,
<br /> D a•a Bacl.v:a'er Prevent�on dev�ce(6VJD)�ti�as installed�i� ,�__ Date th s'nr�,was complete��'�//S�
<br /> Irslallatio� Property Ov:ner IJame and Conlacl Info: ni�a»:�Y �?�n1�r /f —_— '
<br /> Pre�;ecrA��res: :=�o�� �C�.�/ --- .- --- i
<br /> Pre-Installation Inspection Checklist:
<br /> A-!:fem;�r,;,st be cl,er.Aed 'Yes'in order for a BVdD to be consrdered for installation '
<br /> Is lhere a Lasc•na��'o� lerc cf th �hcuse!'ial ,s al or rea�assumed se�ver main elevatior?�I Yes ❑Nn
<br /> A�e iFere t�rtures i� Ihe house locale� belo�v'he opslream s^a�er manhoie rim elevation?�, Yes I N�
<br /> Is 1he si�e se��rer curently UIJPROTECTc'D`�om sevrer Cackups (does not h2ve� 841'D irs!alled)?�! Yes j_f Uc
<br /> Site Inspection Checklist:
<br /> A7 rtem�m�sl Uo chccked`Yes'helore i�soecfio i is cors�dered comp,�ete ,
<br /> 14'as s ae�e�ver T�� irspeeted(rom bu lding lo sewer rnai�? � Ye� ❑ No CondiUan,
<br /> Dces si�fe sewer have at leasl 1°/a siope(ro^i ttie buldi�g;o s�„e•rnair7 (!�Yes �� Nn Descnbe:
<br /> Ha�e a' �Idin�sev.er drai� connecGcns to ihe sidr, sc�;er Gee� iaen:Ged a�d located? �I Yes '_ No ;
<br /> Have all o«�pe1y s!orn d�a na3e conner,'icns fo ihe s'�d� se;rer been idenli5ed anJ �oca'ed� }7]Yes ]IJo �
<br /> I i35 propa�ty bezn ee;�',ia'erl f�r Crainage deLc craes vr tl�t�rdirgs r,o^�n�,.inir,ale�i �n G..n�?ity r,�cner? �' �1'es ,—', ti'� '
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<br /> Installation Details: �
<br /> l�1'�iat fyp^a�iJ bra�d��f EiN:D was in,tailed at t�is site 'M�Checi- Bl'V�TY�nnder �ur�,p. e:r..) --_— . _-
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<br /> 1'i�iere r;;as Ihe dev r.e installe� (ge�^ral descnn'�m, a:fad� nan17 .__�„1L1_���; c�� h_,�,s�_ ---- �
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<br /> I�i a; th,:�;,,,ny;��I�r,ser:r�r or slorm d�a nag� v;ork compi�t?d in co��jancti:;i� wilh Ihe BIND v�ork'� Is so p!ease desr.r be� __ :
<br /> /1/�>� --- I
<br /> Installalion Chccklist
<br /> Nir,d duv:��sF�o.il� and sitc dra�naye d�sconnr�r,lyd(roin upslieam o(ihe BWD7 I,�J'1��, �� No Commec'��.-- -- _ �
<br /> Uor.s f3l�dD posi!io'img mer.ls min mi�m slope reqwremen�oh1%� �Yes ��No Commenis: _ �
<br /> Can B�4'D be pu'led oid to�inspection and main;ena�r.e a'Ir,r lonsen�ng Ihumh sr.rew? �j Yes [�Wo ;
<br /> Is RN'D loc4ed intu;he pro,�er positio�a�d Ih�:mh sr,rev�tighlened? ��Yes � j No �
<br /> Ci•c'�e me BWD r.ev�ng' ��r.over (fardsr,ape �rt�� l��tfir,load br.anrg roeer(dnve surface)l access hatr,h(huilding)
<br /> Vt4is prope�ty o�xner sho,:r the loca:or of the inslalled BIh�D? �'Yes ;] No Commenls:
<br /> � �" , / Dale: ��/7 //_� ..----
<br /> Prnpe�t}�Oe.ner's Sig�al,ue: �71 [(�1.(�? 1� - --. - -
<br /> Inslaller'S S�gnaiu��-='� _ ___ Date: � _
<br /> "/�7�/S
<br /> Revislon: 2 1 fnday,September 12, 201A �
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