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i <br /> ; <br /> - �;c�.�f�,����'t�:'G�.:�S �A'����������E�:�l�; -?����rL �@;'���'��. ; <br /> `�� �yr C���f.��.P�. �'�1�'ft�R� �.;3a�.�e��E�� <br /> .�— — _�...�_ ..r...W�. _. : <br /> inslaliation Company Name and Contact Info:_M Utn j�, Ij:l L/�2 S =�(.G��'3(:u _ <br /> ' 3'�)-I/� <br /> D-nte EaCK�vater Frevenfion de��ice(814�D)r:zs inst�lled: 3 '�c�-I S Dal�this form e,as completed: <br /> !nsfalla;ion ProperF,�Ov;ner\ame antl Contact Info: �s s �,� M ��� �t�( S `"/Z� 3 i�( S,2 �?3 ; <br /> Prnperty Ntldress: I �3_ I _ (-luv� �__ I <br /> Pre-Installation Inspection Checklist: ; <br /> �JI iiems must be checked'Yes'in order(or a 814�D to 6e considered for instaflatron � <br /> is tnere a basement or le'��ei of the h�use tnat is at or r�ear assumed se�ver main eleva;ioa7 �Yes ❑No i <br /> �:re lhere iixlures in the house located belocr fhe upstream see�er manhole rim elevalion? [7�Yes ❑ Ro � <br /> �s th�side serrer curranUy UNPROTECTED(rom sevaer backups(dozs nof have a B4VD insfalled)? � Yes ❑rao <br /> Site Inspection Cheekliet: <br /> �' <br /> ;�.11 rtems must be r.hecked'Ves'be(ore inspsc!ien is considered compiate '; <br /> VJas side se���e;N insp2eted irom 6uilding to seere!main? �Yes (J No Condi!icn: ' <br /> Dozs side sev�er have at leasi 1%slope frorn the t;;Iding lo se:�rer maio? (�1'es ❑ No Descri6e: <br /> Have all building sei�zr drain conneclions to ihe side ser:er osen idenlined and located'? �j Yes ❑ No <br /> Have al!property storm drainage connzctions to the side see�er b2en identii;ed and located? Q�Yes ❑ �o � <br /> !�as property been evaluated for drainage defciencies with fndings communicated to property owner? ��Yes ❑ Ido <br /> Install�tion Details: � <br /> �,i4�a(typz and brand of BVJD lvas instaL'cd at ihis site(Clean Check BINV,Grinder pump, etc.): I'�W� �w L d'�`^��" <br /> !;i'hera��;as ihe device inslal!ed(general descriplion, attach map)? lr4r���-� <br /> ',�ias there any other sewer or storm drainage�vork completed in con;unc6on vnth the BIND tivork? Is so pieaso describe'_ <br /> ti/�� � <br /> Inslallation Checidisi: <br /> ;�re all dovmspouts and siie drainage disconnecled(rom upstream of the Bl4�D? �Yes ❑No Comments <br /> Daes BI��D posiYoning meels minimum slope requiremenl o(>1°lo? �Yes ❑�o Comments: � <br /> Can 9lND bo pulled out for inspection and mainlenance after loosening Ihumb scre���1 ❑ Yes ❑�o � <br /> Is Bl4�D locked into the proper position antl Ihumb scre�v lightened? ❑Yes ❑ �� <br /> Ci��le Ihe 6WD cover: imgation cover{landscape area)1 traffic load bearing cover(dnve surface)1 access hatch(buildino) A//,� <br /> VJas oroper�/owner sho:�m the location oi fhe installed BWD? �Yes ❑No Comments <br /> Property Ov�ner's Signalure: Date: — <br /> Installer's Signature: �-�����--�— Date: �— � s—� � <br /> Rcvision: ? ; PJiu-day,September 15, 2014 <br /> . <br />