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BACKWATER PRE�'�NTION DEVICE FINAL <br /> INSTALLATiI)N CHECKLIST <br /> Installation Comp2ny Name and Contact Info: !�(> >��J (>l � .�,v��'��'� <br /> Date Ba�!�va,er Prevention device(BN'D)was installed: - � "t� Date this form was completed:��- !2 -� S <br /> Instaliation Propsrty Owner Name ard Cort�cl info: v��n� D� 1� <br /> Prope�tyNddress; 13. � v -E'• — <br /> Pre-InsWllation Inspection Checklist: <br /> !+!1 itenis must 6e checked'Yes'in order fw a BV✓D to be cor,sidered for insfal!ah'on <br /> Is there a basement or level of the house that is at or near assumed se���er main e�evation? �j Yes ❑�'o <br /> kre there fiaiures in the house fo:�ted belor�the upstream set��er manhole r�m ele�-ation7(D Yes ❑ ��!o <br /> Is the sid�se�:er currently UNPP.OTECTED irom see:er backups (does nct haee a B!'dD irs'ailedj?� Yes ❑ iJo <br /> Site Inspeetion Che�klist: <br /> Alf items must be checked'Yes'be%��e inspection is ccnsrdered complete <br /> 1Nas side sewer N inspected irom building to se�ver main? �]Yes ❑ ho Condition: <br /> Does side sev+er have at least 1°6 siop2 irom the building to sewer main7 ��Yes ❑No Describe: <br /> Have ali building sewerd2ln connectlons to the side sewer been identified and located? (�Yes ❑�o <br /> / <br /> Have alI property storm drairage connections to the side sevrer been ide itlfied and locatedl �]Yes ❑ No <br /> Has propedy been e��aluated tor drainage deficiencies vrifh findings a�rt��r,unfcated to property ow�ner7 p Yes ❑ iJo <br /> Instailation Details: //�� <br /> INhzt type and brand of BN�D�vas installed at this sife�lean Check BVJV, inder pump,elc.)� <br /> lNhere e:as lhe device instal!ed(general description,a ch�nap). � .,Lu�r� �.�.P G:/ _ _ <br /> �?��Un P�t�"u,�n.c e _ <br /> Was there any other se���er or slomi drainage vrork completed in conjunction��aith the BWD vrork? Is so please descnba_ <br /> /� � _ — <br /> Installation Checklist: <br /> Are all downspouts and site drainage disconneeted irom upslream oi the BW�? [�Yes ❑ No Commenis: <br /> Does BIND positioning mees minimum slope requiremenl ol>i%7 ��Yes ❑No Comments: <br /> Can BVJD be pulled out for inspection and maintenance after loosening thumb scretiv7 (�]Yes ❑A'o <br /> is BWD locked iato the p�ro er pos—itipn.and Ihumbsctew tlghlened? dYes ❑�o <br /> Circle the BIND cover. gal(�ion cover(landscape area)1 U ffic load bearing cover(drive surface)!access halch(building) <br /> Was properly otivner sho�vnUte locatlon-of-the-irrstai ed BWD7 �Yes ❑ No Commenls: _ <br /> Property Oivners Signalure: Date: <br /> Installers Sfgnature: 7 Date: �n � �Z - �r <br /> Revisfon:2 J/ 1 Friday,Septem6er 12,2014 <br />