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����`����� �R�@/�f��'���1 ���6��� �r@�,��, <br /> � ; d�1�+�Pa�,9�R��C'I�f�' C;����K���?' <br /> Ins�allation Ccmpany Name and Cont2C!In'G � = � � f� i �;�� "��� _ <br /> Dai2 Backwaler Prev=nfion d�v�ce fB����)��'�� �ns�alled.__ _Da!� this torm eras comple!ed. <br /> In<;alla'ion Property O�,�ner IJame�nd Coniacl Info IV Q n C i �� �"��`� <br /> ��oG��;��adre5s � 30 5 Gvc��d A v� <br /> Prz•installation Inspection Checklist: <br /> f!N 1(2R75 q1U5( b2 Cf7Er��0 '�(BS I� Ol�jaj lOf 8 6'�Ji��(0`)° CO:tSi;;�91��7 i0f.117S(8��8�10�I <br /> is tn�r2 a basemem or level of the ncuse Ihai is al or near �ssum�u se�•+Er main eievation?�l Yes ❑ �o <br /> Are ihere fi�;lures imth� hcus2 !ecai2d belo�q the up5tre2T 52��:�er n,arhoie rim ele��aiion�fJ Yes ❑ No <br /> �S the s�de sev�er cur.eatn� UiJPVCi r(�'1'Fp IlJfil S?'�:�� Cdi,%:lI�7S IG�C'S ��Di f�a:'B 2 6'����� I115�.o��Q1�� ;(� �'es ❑ Wo <br /> Site Inspection Checklist <br /> All rtems rr�ust oa cnecked Yc5 b9(C�?:,'7o�BChGn 15 �Un�ia=i�:l rOntp:BiB <br /> lNas side ss��+er TV.inspected (ro�n Cwld�ng to se�ver man� (�Yes ❑ No Condii�on: <br /> Dezs side sewer have a; Ieasl 1�5 slope from ihe bwitling lo s2v:er main? [�Yes ❑ No Describe. <br /> Hav2 211 buitding se�ver drain conneciions io ih� side se�.var oeen ident�iied and.!ocaied? �.1'es � No <br /> Hz��e all propery slo�m drainage connections lo the side se�ver b2an idenlified antl �ocaled� f—�X.Yes ❑ No <br /> Hns propeRy been eva!uated for drainage deficiencies �vil'n findings communlc2led to property o,•mer7 �Yes ❑ N� <br /> Instal�ation Details: ����,SL <br /> 1n�hat lypz and brand of BWD���as mstalled a� Ihis s�te (Clean Check B\NV, Grinder pump.etc) C�e���� � <br /> l^.�h�re�':as ihe device inslal!ed (general descnption,attach map)? '.���'����� �^��'`' �' <br /> `ilas there �ny ofher sev;er or siorm d�ainage work tompl2ted in cunjunchon v�ith ihe 6N1D�°�ork� IS so:please describe f <br /> .�O � <br /> Installation Checklist: <br /> Ara ali dovmspouls and sde cireinane disconnected (rom upstream of ihe 81��D? �Ye� ❑ No Comments: _ <br /> Does BINDpositioning meels minimum slooe requiremenl o'r >1".�0? �l'es ❑ No Comments: _ _._. <br /> Can B�A�� be pulled out for inspechon and m�inten2nCe after Ieosering thumb scre�v? �Yes ,[] No <br /> Is BVJD locked inio ihe proper positinn a ;humb scie�a Iighien2d7 �'es ❑ No <br /> Circle ihe BbVD co��er: irrigation cov�r(landscap�d e`��traf�ic load bearing cover (dnve sur(ace)I access ha�ch (builtl�ng) <br /> Vdos p�operty ovrner sho�^n 1he locat�on of.�he�nslailed BWD7 �Yes ❑ No Comrnents: <br /> Properl� O�vner's Signature I �1��!"i�� ��"" .� _ Date � � � � - - —. <br /> installer'3 Signafure. ����--C�-Q _ '��.�_� Dale Z � �� I�5 <br /> Re���s�cn�. ? 1 F�iday.'Sep!ember �12, 2014 <br />