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�� � BACKWATER PREVENTION DEVICE FINAL <br /> INSTA�.LATIUN CHECKLIST <br /> ; (� <br /> s• �"�,:: _ .. rn � I I�� � . .�r; C'.�lad �nio� .�.{����'1 ����LL�� T�L �i�9�1�� lil�� � l�: � . _ <br /> �.�li�_' �2C'{;:a"�f� D•6,.li."��li.'I1 :.f:��C� �LZ�t'1L7�V12S If1S�8��Cf1�. � Z�//� �3�C �f'IS �CfT� �!!�S CO�Ii�`.CiBij. / �`r /3� ' <br /> _.�_._-f--__— <br /> Ics1a':�lion Prc�ert; C���:eer �]am� and C�Nac' !�`o�__�t,����v ���Cr'_�i�--�_2,2��2;2-S�Sc� ' <br /> t <br /> �rc�e,t.; AcJ�rss -- _l �/0t'__1yo�;.l--f_t`�z---- - fvel�/T <br /> ?re�lnstallation Inspection Checklist: <br /> ��,�'�rn� n��i;t be r.hnc-•�^ '4'as'in cr�;�r lor a BV✓D fo be corsidered�or insfalla(ion � <br /> S illC'� 8 �85CR1Ef1� 0�i°VF�J�ih2 hOIJ�E tf18I IS 8t Of F38f 05511ff1Ed SeWEf R121(1 P.�C'Vd�:O'1� �BS ,_j i`i0 . <br /> r'.'P','19fB +'K�ti(e5 If: �f1C h07liC ��::�i8(� �'E��'„!FF3 U:15���d71 5='�5'C'C'd:lr.^.�C �l'Tl l,-'��89��0�! �_j 1'?: � �`�0 . <br /> .: 'j:c 51�•?S.^.�:0f C..R��':�; 1���{�i�T�.r.TF.I '7111 SCC,. �..��.•;'�:.=((;Jr_ ^C1 �'I"3'.�i: �',iL7 �I�S d�'C.'�il� �., 1.°.5 , �. 'VC � <br /> Site fnspection Checklist: <br /> -� �.C�i'� 'ru5�b2,�i .C.Bi �y85 �"`�_f•: jCJ � : .J iS � nt�('plCOCfTf1�'�C ' <br /> / / <br /> ' a< ;�d= se;.er N i sae .ed`�u�n buiidirg tc se ver mai�� '`✓e� �] tJo Corr'i"o� i/�/� ��`� _ <br /> D�es side see.er have af least 1°6 slcoe from ihe build ny te se�ver mam? �Yes [j Nr� Da;crib> _ _^_ <br /> -:v^all buildir,a se;�;er dr?m connections to ihe side se�:er been identified 2nd localetl� ��`'"�es ``_ tv� <br /> a�._� all propen�slonr drainace conneclions to the side se,aer been ,der.Ufed and located? [yYes ❑ No <br /> � -�p��rty been evab�e(ed(or drainage de6ciencies�vi:h tindings coinmunicatad to property o�vner? —�]'�'es ❑ No ; <br /> Installation Details: - <br /> �,°,���:��� �°�ce an:l hrand oi BWD was inctalled at this s�; � (Clean Chack BVJV rinder pump, efc.J ___ _ <br /> �i_����c,as :hc cevicc �nstalled(generdl desr,nptio a!Iach ma�}' ,- ---Qrr.—l. �='°-,=---���ws`-�-- <br /> r- 'h���e any ofher sew2r or storm drainage��+ork completr:d in r-onjunr,l�on v:lth the BWD work? Is so pleose describe N�� <br /> I utallation Checklist. <br /> � �i'�So�, �� �cuf; ;�c� ;i�e d �-r i ��� J�s?nnnecfed hr,m upstream o1±he WD? --' es ❑ No Comments -- --_ <br /> � .��."�� �i�:n �,051�10l11'1� fil(;P.iS fillfll!IlUlil SIOF?� �!:�Ulf���?0!Of >�°j� L CS �_� NO C.�.0/1T)�1L'I1�S� ___ � <br /> �_:; ��UD be pulied nut for inspection and maintenance after loesening Il�mb screw"? !�Yes ❑ No <br /> :�'1:D locked inlo lhe proper position and thumb screw tightened7 �Yes LJ No <br /> .? (he BN.�D cover. urigafion r,over j'andscape area)I Irffir,had t ariny cover(drive surfaco}I access halch{building) <br /> '.':'�r properiy ativner sho�an�he localien o(Ihe inslalled Bl'�;U? [_� Yes �� No Commen(s: ________ __ ; <br /> � Propeiiy Owner's Signature:--��j/ _------ —_ Gafe _ I '� �- �-� ' <br /> .� / <br /> Irta9er's Signa!ure:�lLc„r� --.�---/Ji�i�i'?��rp'�. --��--- Dace _-�z-�; /�f' -- - <br /> r_,� <br /> 7 <br /> . . .. .�ri 7 1 klC'i�l.i;. � ���JL nt�n,. I^. ,'lll:t <br />