Laserfiche WebLink
i <br /> I <br /> �/'4iafOV"J!'91Cf� �6��@9�I�d�i�1� �.JLVIIi� I�fIYO'i� i <br /> 1���'�LLr�T1C)E� �H���LIS�' � <br /> � <br /> ; <br /> , <br /> Installalion Company Name and Contacl Inio:�6,> ��!�,;/�� L- LC- � <br /> � <br /> Date Back�valer Prevention devic2(BN�D)�vas installed:�L'L�j/ls �pate Ihis(orm was completed: I <br /> 1 <br /> Installation Froperty Owner Name and Centact Info: ��'i�� � C����Y'�-jn�l � <br /> Property Address:���1 (0��,� Gy�,p � <br /> Pre•Installation inspection Checklist: � <br /> All ifems musl be checked'Yes'in order for a BIND to tre considered lor insfallation ! <br /> Is Ihere a basement or level of the house Ihat is at or nezr assumed se�ver main elevalion?[�J Yes ❑ No ; <br /> Are there fixlures in the house lo�ated helow 1he upstre�m sewer manhole nm elevation?,� Yes ❑ �'o � <br /> Is the side sewer curtenlly UNPROTECTED trom sea�er backups(does not have a BVJD installed)? �Yes ❑ No ; <br />' Site Inspeciion Checklist: i <br /> All iiems must be checked'Yes'before mspection is cons�de�ed c�omplete ` <br /> Was side sewer 7V inspected from buitding to sewer main? �Yes ❑ No Condition: ; <br /> Does side sewer have at least 1%slope from the building to sewer main9 �Yes ❑ No Descrbe: l <br /> H;ve all building sewer drain connections lo the side sewer been identified and Iocaletl? (�.Yes ❑ No , <br /> Have ali property storm drainage connections to the sitle sewer bee�idenlifietl and tocatetl? (�;,Yes ❑ No i <br /> Has property been evaluated(or drainage deficiencies v+ith findings communicated lo property owner7 [f�Yes ❑ No � <br /> Installation Details: j <br /> What type and brand of BWD was instalied at this siie�Clean Check 6WV, Gnnder pump, etc.) Cl t av� c�e c-�L i <br /> Where was the device installed(general description,attach map)? �-1_si� �c�J 5 e � <br /> ; <br /> INas Ihere any other sewer or slorm drainage work completed in conjunciion wilh 1he BWD vaork? Is so please describe:` � <br /> v�U ; <br /> Installation Checklish ; <br /> !�re all downspouts and sife drainage disconnected from upslream of the BWD? �Yes ❑No Commenis: � <br /> Does (3WD positioning meels minimum sfope requiremenl ol�1°�b? �Yes ❑ No CommeNs: ' <br /> Can BWD be pulied oul for inspection and maintenance a(ter loosening Ihumb screw? �.Yes ❑ No � <br /> Is BIND loeked inlo the proper posilion a Ihumb screw lighlened? .�Yes ❑ No � <br /> '- � <br /> Circle Ihe BWD covec irrigation cov r(landscape area I ira(fic load bearmg cover(drive sur(ace)I access halch(building) � <br /> Was property o�mer shown Ihe locatio ot the Installed BWD7 ! Yes ❑No Comments: _ ! <br /> � � I <br /> Properiy Ovener's Signalure: _ Date: j <br /> Inslal!er's Signature: �-Q- Oate: Z��7/�� ' <br /> i <br /> � <br /> Revision: 2 I f'riday, Sepiember 12, 2014 � <br /> I <br />