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���� � �'�>F 1-'���d �i � � �'�;f � ��.���_ i � : di., tlFi� � .�k °r _. ��L, :�p ..�.. <br /> ',� ��' <br /> I�. � �� i-� 5�j fl { <br /> �'�Fu�rEr- 8[�1'��'���4 '� ..�'z; n �' ��i�,i R "'�i��E�"o p ��; j.. <br /> ;� "/ <br /> Installalion Company Name and Contac�Info: �,"�;_;�Il {-;':r;r�,�%� <br /> /------------- ---- <br /> I'ale Bacl;tvater Preveneion device�BIND}v�as inslal:ed: � I Fl I �S ` Ualr I'�is ;crrn ,+as ceu�pb;lcJ _I � � -�l�>_ <br /> histallatiun Properiy Owner Name and Coniact Info: �UV 1 C� 1�, �� ,yv ___ __ <br /> P�ooer,yAddress_ 1221 C't�G�l��,�t __�'v=e— --- ------------ <br /> Pre•Installation Inspection Checklist: <br /> �';irems must he cliec�ed'Yes'in a�ier fo: a 6L'JD to be conside!ed lor installatio�i <br /> s !here a basemeni or le��el c(the house lhat is at or near assumed seta�er main elevation�� Yes ❑ ;d�� <br /> ��.�� there lixtures in th� house localed belov+ Ih� upslream se�:�er manhole iim ele��aiion% (�,�,Yes � i�i ; <br /> I: tre,ide se�vcr currently U��PRUTECTED from sel��er bac;ups(dc=s no1 have a B�A'D ins!au•�ci-'�'? ';zs ; -_ �„ <br /> Site Inspection Checklist: ' <br /> Ail dems must he ch,ed;ed'Yes'belo�e insP�ction is cunsiaered comp'ete <br /> 'r:as side sewer Tv inspecled from building to se�ver main? r[]Yes ❑No Condmon.___ __ <br /> Coes side se�ver have at leasi 14o slope irom the building to sev�er main% �Yes ❑ No D�scrii�e <br /> I!3ve all building se�ver diain conneclions lo ihe side sev;er L•een idenlified and located7 �']Yes;� No <br /> i��:ve all property storm drainage conneciions lo Ihe side sewer been identiAed and located^ �J Yes Q flo <br /> !��s properfy been evalualed for drainage deficiencies eiiih findings communicaled to property osvner% �{] Yes ❑ Mo <br /> !nstaliation Deiaiis: � <br /> :';hal type and brand oi BWO�vas insialled al Ihis sife(Clean Check 6bVV, Grinder pump,etc.) L� Cu1 �.<<�(:`. <br /> `,'�iere!�;as Ihe de�vpice installed(qeneral d2scription, allach map)? ___v. 1 ,, ,�, �. .p <br /> — �--��`—'�=---����=n=eJ t—.SS�L__Lz��_—�/s1�_ �--- <br /> Vi�as L'ieie any oiher sewer or sto�m tlrainage wod� compleletl in conjunction v�i!ii the BVVD worlc? Is so plerce cascnh�. <br /> — ---- V�-U <br /> Installation Checicfst: <br /> ���e all do�vnspoufs and sifc dr�inagr, di;r.onnected irom upslream o(Ihe �WD? ,(Y�Ye, Q No Commenf, __ <br /> fT:��� D1ND posilioniny mer.is minimum slopc requiremen� of >1%? [� Yes ❑ No Commenls. ___ _ _ <br /> �:,,n 8WD be puCed oui for inspeclion and maintenance after loosening fl�umb screw� [�],Yes ❑ �'o <br /> ra �!4�Q locked info ihe proper position and thumb sciew hyhlened? � Yes ❑ No <br /> __ _—t_. <br /> Circ!e ihe BWD c�ver. iirigation cove�(landscape area).l�raff�c load bearing cover(diive surfzre)I access halcn (hu�id�n�l <br /> ::'�:; propeny or+ner shown the localion of Ihe insla�ed �1ND? [�Yes ❑ No Commenls . �_ __ <br /> / <br /> F'rc,perty0emer'sSignal/�� !//..�� --- Date: _��d� - <br /> I: ,faller'S Sigr�atUre!/�%//l./ i ,�� / �� . _ Da�e _�__� I 3_��--- <br /> f:evision_ 1 ( Fnda��. 5����terrbrr 1!. 101J <br />