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� 8�+��CWATER FRFVENTIJN DEVICE FIN�1L <br /> E� If�STALL�TION CHECKLIST <br /> Installal.un Company Name 2nd Con,act Info:��l �-f� � l�m�7�-�a yz� 3c�-7 /S4� <br /> Date Bac�cr,zter Pre:�ention device(B1ND)�rras installed: Sl�� Da'e tn;s form,s�as comple:etl' ! i5 - <br /> InstallaGon Prop��ty Ormer��ame and Ccnt2ct Info: LCA� A NUE�So►J kZ������_ <br /> Property :+ddress�. lD /7 ,�p�_ V� V t2GT7" W{} 9�'02 1 <br /> Pra•Install2tion Inspection Checklist: <br /> !JI i!ems mus!be checked'Yes'in oroer for a Bl4iD to be considereo for inst211ation ,� <br /> Is tnere a basemenl or Ie��el of the house ihal is at or rear assumed se:•:e�main elevation? u�s �._] I!o <br /> A�a iher�tiziures in tne house loczted bzlo:,�ihe upstrezm sev;er manhole rim eleva`ion7 �1'es ❑ f�!� <br /> s tn� side se�•�ar eurre��tly UF�PP,OTECTED fror,�� see+erba,'�ups (do°s not have a Bl^1D '�nst�i'ed}? f 1'e; I i ��!o <br /> Site Insp=_ction Checklist: <br /> i��j j;'E'115 7iif1S�bB C�7BCkB0��YES'�?!uIB l�5�76C�IG!7 I�f,0liSlljBf?d COIIIfJ�°fB <br /> `;:�zs side se�ver N inspected from huilding to se�ver mair? �'i es ❑ No Condition: _ _ <br /> Does side seuer have at leas,1%siope trom the building to seveer main? [�1'es ❑ I�o Uescribe. <br /> Have all building see+er drrin connections to the side se�ver been identifed and located? �es ❑ I�o <br /> Have all properiy storm drainage connec!ions to the side se�ver been identified and focated? �Yes L I Ido <br /> Has properfy been evalua(ed for drainage deficiencies�:�iih findings communicated to propzriy ovdner7 [�es ❑ No <br /> Installation Details: <br /> \'!l;at type and brand o(BVdD e�as inslalled at lhis site Clean Check BVJV rinder pump, etc.): <br /> ';';�f�ere v�as th�device insfalied(general description,atlach map)? .__��7__p�F 1+n�5L-� �N [_As i SLCY= <br /> S►�_�C,1c l.�.l� -- - <br /> 1'das there any oth�r se�•rer or storm drainage�+�ork comp,eted in conjunctien�ai�h the BVdD�vor�7ls so p'ease desci ibe: __. <br /> �� .cnl.� S�,OL—SG_�1i.R—�4_��G�Cp�stm�R.���2� <br /> Installation Checklist: <br /> Are ail dc:•mspouts and sife tlralnage disconnecled irom upstream of the BI°dD? �Yes L] �do Commen(s: ___ <br /> Dr,es BWD posllioning meets minimum slope requirement of>1%? (�Yes U IJo Comm2nfs: _ <br /> Can BVdD be pulled oul for inspeclion and maintenance after looseniny ihumb screv+? ��'es ❑ No <br /> Is BVdD locked into�he-pr er posi ion andlfNmb��ightened? �{,1'es ❑ No i <br /> Circle ihe BWD cover irrigalion co��er(landscape ar�a tra(fir,load bearing cever(drive surface)/access hafch (building) <br /> 1�'as property oerner sho _ � cation o �e installed BN'D? [�es ❑ h'� Comments: <br /> Proper?y Ovmer's Signature Date:_l��ll J` <br /> Installer's Signature:, i���[��'_` Date:�t,� i <br /> Revision: 2 1 f�donday,September li,7_014 ; <br /> I <br />