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BACKWATER PREVENTION DEVICE FINAL <br /> a' INSTALLATION CHECKLIST <br /> I�sta7a:�on Company hame�ntl Contact Into� �v W S�'�(JE?l��f-l�✓I!� t•1 <br /> Date bzc;ti•�ater device(BIND)�vas installed:�� a� /� Da'e this 10 m��as comoleled: I�?� 3T_ <br /> Instatlalior Properly O::ner Name and Conla�t In(o: `5 7 r���'� �'lt. <br /> � <br /> Pro,^.crtyAddress:� �-7l�'Li� .��,-�� � �l�t'-� /�� �i��J�.)� <br /> Pre•Installation Inspection Checklist: <br /> �i�'i�ems mus!be checned'Yes'in order la a 8ND to be considered for installaUon <br /> Is !cere a baserrent or level cf the hous>that is al or near assumed sewer main eleva6on? [%Y'i'es f_j P:o <br /> Are�nere fxfurs in tne house loeafed bclow tne upstream se�.ver manhole rim elevalion?�Yes ❑\�o <br /> Is t�z side ser:er currently UNPROTECTED irom sewer hackups(dces nol have a B�ND instailzd�?�j Yes U i;o <br /> Site Inspection Checklist: <br /> !II items musf be checked'Yes'be/ore inspection is considered complete <br /> lNas s�de se:�ier N inspectzd(rom building lo sevrer main? �Yes ❑No Condition: i�f'!�'��i f�i,S�.'l��-�-!; �i�1�"! <br /> Does side se�r;er have at least i°io slope from!he building;o sa�.rer ma�n? �Yes ❑No Describe <br /> Have a!I building sei:er drain conneclions to fhe side setiver been identifed and Iccaled? �{ Yes [] No <br /> Have all property slorm drainage connections to the side serrer been identifed and luca!ed? [�Yes ❑No <br /> Has propetty been eva!ua;ed for drainage deficiencies with findings communicaled to property o�tir,er? �Yes [ �N� <br /> Installation Details: ! <br /> 1Vhal,ype and�rand of BIND eras inslalled at this s�le(Clean Check BVJV,Grinder pump,etc. :C!P�2i'� G��1�'G�G��V <br /> ldl�ere e:as the oevice instailed(general description, attach map)? SL�� C LNl�(?(�(j� P-�;'�$e�'?'7(_/��_ <br /> l4'as Iher�any ofher setver or storm drainage�t�ork completed in conjunction�vilh the AB4VD�vork� Is so ple se desr.r�he: <br /> 1�`IStCt(.Irl7� .�'� C'-//J� /�f',Y11?G� �f'/L."'J "17 ��tP� � llJ1Si � � <br /> -� . � _ �� !_ l <br /> Installation Checklist: — <br /> Are atl dor;nspoid;and site drainage disconnecied from ups'ream of fhe BWD? �J Yes ❑No Comments <br /> Uocs Hl4N posdioning meel minimum slope requiremenl of>1°/,? �J Yes ❑No Commenls:_ _ <br /> Can B'NV be pulled oul(or inspeclion and maiNr.nance afler loosening fhumb scro�v7 �Yes ❑No <br /> Is BWV lacked into the pmper position and Ihumb scre�v tightened? �f Yes ❑No <br /> Circle ihe BtNV cover:irrigalion cover(landsr.ape area)I tra(fic load hearing cover(drive surface) access hatc(buiiding� <br /> V�'as homeo�:�ner sho�vn ihe location o(the installed A��h'D? `(—�j Yes ❑ �o Commen�s: <br /> ' , r� � <br /> Property O�vner's SignatffR:. ' '1,L �t� Date:��' �� <br /> Inslaller'sSignature: ��� �I � Date: I -1 �� /S^ <br /> Rrei�ion: 2 1 I Thursday, Or.lobcr 02, 2014 <br /> _ - I <br />