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i, <br /> I <br /> I <br /> �AC�VII��'�� PR����91'@�N ��V9�� �BNAL ; <br /> E6�S°f�1@..9..�a li'9Q6\9 ����&C�B�°sT" i <br /> � <br /> �-�,.�..�,�� � <br /> •— � <br /> � <br /> Instella�on Campany Name end Contact Info: M UP� ���,r,�it,� � � ��U �?6v � <br /> -- ���� � <br /> Date Backwater F'revenlion clevice(EWD)was installed: $-3-f.f'' Dale this torm was compleled: �' 3^�f` � <br /> InsfallationPropsrtyOwnerNameandContactlnto: �n:el S G�c.. �k<. II�-ui�.y�f- 7�-y ��c; � <br /> i <br /> Property Addre;s:�(t �G,r 5�}. � <br /> Pre•Instellation Inspecllon CheckHst: ' <br /> All items musl be checked'Yes'in oider lor a BbVO to be considered forinstallation I <br /> Is there a basement or level oi the house ihat is at or near assumed sewer main elevation?�]Yes ❑No <br /> Are Ihere fixture>in the house located below fhe upsUeam sevrormanhole rim elevafion?�Yes ❑No ; <br /> Is lhe side sewer currently UNPROTECTED from se�ver backups(does nol have a BWD instailed)?(_k]Yes ❑ No � <br /> Slfo Inspeefion Checkiisk <br /> i <br /> /dl ifems must be checked'Ves'beiore inspecfron is considered complefe / q j <br /> Vi�as side seiver N Insper.ted from building to cewer main9 �Yes ❑ No Condition: �S UU 1 ; <br /> Does side sewer have at laasi 1%slope from the bui�ding to se�ver main? �1'es ❑No Describe; __ � <br /> Have all bullding sswer drain connections to the side sawer 6eim identified and localed? � Yes ❑No <br /> Na��e all property slorm drainage conneclions fo the side sewer been identiiied and located7 �Yes ❑No • <br /> Nas proporty bsen evaluafed fordrainage deficiencies with findings commun(cated lo property ownar7 �Yes ❑ I�lo � <br /> Insfallatlon Defalis: <br /> What type and brand of BWD was installed al this s�e(Clean Check BWV, Grinder pump,elc.)� �--��� c.C.�_�h_ ; <br /> Where wes the device InsWlled(general descnption,elfach map)? c ��.c L,a ���,� <br /> I <br /> Was there any othor s�wer or storm drainage work r,omplaled in wqn�jun�ction�vdh ihe pWD��ork?Is co plea5e doscrlbe:� <br /> -- -- --------------- --f�--� - -- <br /> InstallaUon Checldist: <br /> � <br /> Are all downspouls and site drainage disconnecletl irom upstrcam of Ihe DWD? �SJ Yas (_f No Commenis� ' <br /> Do2s 9WD pnsitinninc� meets min(mum slope requirement of>1"/e? �Yas ❑ No Camments: <br /> Can BVJD be puUed out tor Inspectinn end maintenance aRer IooseNng Ihumh screva? ��j Yes ❑ �o � <br /> Is RWO Iocicetl into Ihe pmpr.r po�ition and thumb scre���tighfened� �IYes ❑No j <br /> Cirr.la thA BWD covar: irrigaUon cover(landscape area)/lraffic load beering cover(drive surface)1 acr.ess halch(building)N/J� ' • <br /> Was propory owner shown the Incalinn of Uie inslalled BWD7 �j Yes ❑No Commen�s: � <br /> I <br /> Property Ownor's Sipnature:� _ Date: <br /> Inslaller's Signature:���`--- _ Dafe; � "?` � S� <br /> i <br /> Hevislon:l 1 Monday,Septemher 15,2014 , <br />