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I <br /> ! <br /> ��.��A��� ���V�FI`E�O� ��V��� FINAL. <br /> � <br /> 9�4��'6�L��TR�6� ���C�L9S�' ' <br /> ; <br /> . �.�.� � ; <br /> Inslallation Company Name and Contact Info: MUP�/� �i�,�ti��;.� u a� 7�,U��6c� � <br /> Da te Bac k wa i e r Pre ven tion d evice (B W D)was;;�s ta l le d:7' �' 1 f�Oa te t his iortn vdas comp le te d: `7—�—� � � <br /> Insiallation Property Ow�ner Name and Contact Info:M��.r�`� `l � f'� � �� y}y � � <br /> � <br /> Property Address: I�vD 1 ('rz,., Z �,-�_ �, . � <br /> � <br /> Pre•Installatlon Inspection Ghecklist: �i <br /> All items rnust be checl�ed'Yes'in order lor a BWD fo be considered tor installaGon i <br /> Is th��c a basemenl or level o�the house thai is at or near assumed setiver main elevation?�Yes ❑No j <br /> Nre there fixfures in the house locaied below the upsfream sewer manhole rim elevation7 0 Yes ❑ No � <br /> Is lhe side se�ver currently UNPROTECTED!rom sev�er baekups(tloes not heve a BWD insiallPd)7 (;�Yes ❑No i <br /> Sife Inspoction Checklist: j <br /> All itoms musl be chec�ed`Yes'betore inspection Is considered complete � <br /> W�s side seU�er N inspecled irom buiiding to sower main7 �Yes ❑ fVo Condi�ion: �°NU`�-�-e- SU'`� `�'r� <br /> Does side setver have at le�st 1°G slope from lhe building to se�ver main? �Yes ❑ho Describe: (i�o� ��� <br /> liave all buil�ing se�vor drain conneclions to the side se�ver beon identiiied and locafed? �k]Yes ❑No <br /> Have all property storm drainaae connections io the side see�er been identified and located� �Yes ❑No <br /> Has property 6een evaivated for drainage deficiencies a�iih findings communicated to properiy ov,�ner? �(Yes ❑ P!o <br /> Ins{allation Defa(Is: � <br /> N�hat type and brand or BWD was inslalled at this sile(Clean Check Bl4N, Grinder pump, etc.): G�e� c(_�� �`, i <br /> Where was the device installed(general description,attach map)? W�� � s'�� � F C�.�-.r.� �, � <br /> Was lh?re any other setver or slomi Urainage work completetl in eonjunetion with the BWD v��otk7 Is so please describe:_ ; <br /> -- - '-v��= <br /> Installation Checldfst: i <br /> Nre all downspouls and siie drainage disconnected from upsiream of the BWD? ❑Yes �No Commenis: � <br /> Does BWD positioning meels minimum slope requirement of>1%? '�Yes ❑�Jo Comments: ! <br /> Can BUJD be pulled out�or inspeclion and mainienance afler loosening fhumb screw? ��Yes ❑No i <br /> Is BVUD locked inlo tho properposition and thumb scret��iightened? �(Yes ❑ Ido � <br /> Circio the 8W0 cov : irri ation co_ve (landscape area)1 iraffic loatl bearing cover(drive surface)!access hatch(Uuiitling) • <br /> Was properly ovener shown Ihe location of the installed BVJD? �]Yes ❑ No Commenis: _ ; <br /> � <br /> Property Owner's Signature: Date: _ , <br /> Inslallers Signature: ��fZ---�— Date: 7— 1 —l � <br /> Revision: 2 1 h1oaday,September 15,2014 ' <br />