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<br /> BACKWATER PREVENTION DEVICE FINAL ;
<br /> � INSTALLATION CHECKLIST �
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<br /> Ins'allat on Coropany Ua�ie an;l ConWU In10 �'� .���1����`�;�,;,, �
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<br /> �ale Backv�ater Prevert�or device(B'iJD; �:;as nsla!'ed J� � �5 Daee Ihis forri ti•:as �ompie:e:l -� ��
<br /> Ins'allation Properly 0�•:ner Vame and CoMact 'n'c,�,�Ol'l,r�g�t�A�(�,__t��n�'1� ��-
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<br /> Property AdAress c�l�%��,� L�`L"''�p <l t `Z����� �
<br /> Pre•Installation Inspection Checklist:
<br /> Aii 1!ems mus!t�r checked Ves'ia order la a Bl4�D to be considered(or mstafa6on
<br /> s Ihe�e a basemen;or level o+ Ihe�iouse Ihel �s a'or near assumed seu�e� mai�e'evation� �1'es U tJo �
<br /> r',rc Ihere hxlures fn U�e housr. Ir,cated belor�Ihe ups'ream sevre�r�anho e rim eleva'�or� �Yes [� Vo !
<br /> Is itie side see:er ur�ent��y JNPROTEC'�D Rcro sewr,� backups(does no!have a Blh'D insta led;� �(;�"es [ Nc �
<br /> Site Inspection Checklist: �
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<br /> !ei dems musf be cher.kp,d 'Yes'he/ore inspect+cn is r.ons�dered r,cmplefe �
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<br /> ',1as sidc ser+c�i V inspected fro^i bundmy to sev:er main? �}�'es � . 'Jo Cond�;io� \-���F_ �' ,,,.,,^-„k ,;�-�. �
<br /> Does side se�;er have at 1e25t t°: slope Iro�n ihe bwld:�ig b se��,er �ain'� []��ves � tJo Desu he �
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<br /> H=.�e a�l bw ding se,�e�dran cen�ectio�s to the side sev;er been identdied and Iccated� �}Yes ( _� tJo i
<br /> fiave a'I property storm dra rage con�er.t ons to U�e s�de sewer been identih��1 ard localed� � Yes [ _; No �
<br /> Has p�oper;y been evah�a;ed for draina�e def�ciencies�vAh 6ndirgs communir.ated to property oeme�� GO Yes ❑ �o I
<br /> Installatiun Details: �
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<br /> 11'hat lype and bra�d o`BWD v,�as inslalied at this si(e (Clean Check BNlV Gr�nr.er pump,e'c }� (��S �.✓,� ' (u�C '
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<br /> 11'I�ere v:as �he device installed f general desciiption,a!tach map)� 1��,)_�_���,�__c�('�AS�r,'��_ �
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<br /> t1'as there a�y other server or sto�m drainage rrnrk romple'ed in con�unctinr w�th �he��1'D e;aK� Is so please desuibe _
<br /> l �v,'� c' i Yl.� `�� �.,� ev } Q s_r�� O�� �.�nuC� �
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<br /> Installation Checklist: j
<br /> A�e all downsonuls and sde dra nage d scnnnected IroM ups�rearn ol Ihe �VdD� (�1'es J No Con•menlsan,�C�a.-x�,`<� �
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<br /> Does Bl1'D posiliorrng meels minnnum slope iequiremenl of >1';b� �-1�es n No Comrierts �
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<br /> Ca� 9N�D be puled out fnr inspection and main;enance al;r,r !oosenmg Ihumb sr,�e�v7 �Ycs ; � No ;
<br /> Is 81ND locked into Ihe proper position a�d Ihumb screv�tightened7 I�Nes IJ No �
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<br /> Crde the BN1D cove• irngatien cover Qardscape a�ea) I tral(�c ioad bear��g cover(dnve suriar,e) � access hatch (b�Idmg) ;
<br /> 14'as property ov+ne� shown the �ocalion ol tne i�slalled BWD� lr!Yes �� No Comme�!s: � �`+E� �-�k
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<br /> Pro,,erty Owner's Signatu��e4i�ciP� ,�o��t.,�._,.�o., Date.. ��j I�� 15 �
<br /> Inslalle�'sS�gnalure ��.+vJ.�-.,�`+,.1�"—' , Da!e � �' � ;
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<br /> Revision�. 2 1 Fnday, Scpternber 12, 2014 �
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