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i <br /> � BACKWATER PREVENTION DFVICE F�NA� <br /> �� INSTALLATION CHECKLIST <br /> ��s,a',,�'rn Ccr,�,any N2o�e acd CcNAC� If1I0: G//G /'/u ��3�.-c ��/S-'S� ��7� /So7 <br /> �:;ta Bac4nvater Prevention device(BLh�D) �vas instalied:�,J�.s"=D�i� 'h!e ;orm:�ras comp;e(ed: / � /S` <br /> Insta�lation Prop=rty O�.�ner Name and Contact info:r+G�Y Mo+/Phy --- <br /> F�C��rt)�Address: ��6 �iel7.�� ru�/e•ff wA 911zv/ <br /> Pre•Installation Inspection Checklist: <br /> ;i 7 '�:ms �nust bs checked'Yes'in er�e�(or a Bl/✓D fo be considered lor instailation . <br /> �� ;`�era a basemsn�or 1ev21 of the house thaf is at or near assumed sev;er main elevation?[�Yes ❑ I�:n <br /> ;;re there fixfures in the house localed belo�N the upstrtam sevaer manhole rim elevation?�]Yes. ❑ t�o <br /> I� the side se,ver currentl��UNPP,OTECTED from sewer backups(does not ha��e a Bi":'D in�talizd)?�l'es ❑ I<o <br /> Site Inspection Checklist: <br /> ;V; te,ns must be checked'Yes'6efora inspectron is cunsidered comp'e,a <br /> 1',as side sewer TV inspected from building to sewer main? ��Yes :_; i�o Co:�tli±lon: __ __ ___ <br /> Dces sid�se�•rer have at least 1°o siope f�om the buitding to se�ver main? �'es ❑No D=scribe: <br /> Ha�e a�l hullding se�ver drain conneclier�s lo the side se�ver been identified and located? (a Yes ❑ No <br /> H��;e a�,property slorm drainage ccnneciions to the side se�ver been idenlifi�d and located? �Yes ❑ tdo <br /> i;�s propetty been evaluated for drainage deficiencies�vith findings eommunicated to pro��ri��o�::r�;? �l��s ❑ No <br /> Installation Details: <br /> �::'h;3t l��pe and brand of al'�'U was instal!ed at Ih;s sife.C�Iy ieck BV�N nnder pump, ut�:.): _ <br /> 1':'nere was the devir,e inslalled(general description, atlach map)? (���ti �l t+�,��e 1��. �• �"'_ <br /> �c.i7 t.—9�`� <br /> !�da;tiiere any o!her sewer or stcrm drainage�e�ork completed in conjunction with the BWD work?Is so please describe: __.. <br /> �il� <br /> Installation Checklist: <br /> ,ve all do�vnspo�ts and sile drainage disconnected from upstream of the BVdD? Yes ❑ No Comments:___ <br /> Does BIND positioniny �^eels miniir,umslope requirementof>1%? �Yes No Commenis: ___ <br /> Can BIND be oulled out for inspection and maintenance after loosening thumb scre�v? �]Yes ❑ N� <br /> �, q�r,rn Inr.ked into tha proper posilion and thun•,b scre�v tighlenedl p/ Yes ❑No � <br /> r <br /> �irde lhe BW�co��� ir ir q iionsouer-(Ja�eseaE:e�r�r � -irafflc load bearing cover(drive surface)I access hatch (huilci;ng; <br /> `;das property o��mer sho�vn the location of the instatled B14�D?�Yes ❑ No Comments: <br /> Prope,ty Owner's Signature: . %�%2��� � �ll���" -,J Date: ����s� <br /> I�staller's Signa�af� 1 \� - �/ Date: /�G,is' , <br /> i <br /> Re��ision: ? 1 fvlonday,September 15,2014 I <br /> i <br />