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� <br />� <br />BACKWATER PREVENTiON DEVICE FINAL <br />INSTALLATION CHECKLISi <br />histallation Company Name and Contact <br />Dafe Backv�ater Prevention device (BIND) was installed:�v` 1v1�/�.5 Date ihis for�das completed: YJ�I�'�"/� <br />Instaliatiur Property Owner Name and Contact Info: �f�l ���d �s�� / L C� e rr u!'�- ����"" jPf <br />.�,� r. i..�oP.-- <br />n Icr � i P �' Ve �2-'� r � L�/��s� %-d / <br />Properly Adtlress• G a( L�q ��%r'� <br />Pre-Installafion inspection Checklist: <br />q0 items must be checked'Yes' in ader (or a BU✓D to be considered for install�tion <br />Is there a basement or level oi the house ihat is at or near assumed sewer main elev,iion? (� Yes ❑ No <br />Are there fixfures in the house localed below the upstream sevrer manhole rim elcvation? � Yes ❑ No <br />Is the side sewer currentiy UNPROTECTED from se�ver backups (does not hava a BW� installed)7 ((j Yes ❑ No <br />Site Inspection Checklist: <br />All items must be checked 'Yes' be(ore inspection is consrderetl complele <br />UJas side sev,er TV inspected (rom building lo sewer main? � Yes ❑ Nn Condition: �� <br />Does side sewer have at least 1% slope from tfie buildiiig to sewer inain? �Yas ❑ Na scribe: z) G'c, ��r�� <br />Have all building sewer drain connections to the side sewer been identi(ied and Ior,aled? � Yes ❑ Ido <br />Have all pro�ierty slorm tlrainage Connections to the side sewer been ider.,,fied and localed? � Yes ❑ No <br />Has property been evaluated for drainage deficiencies with fndings communicatetl to property owner? �Yes ❑ No <br />Installation Details: % �� <br />+iJhat type and brand of BWD was installed al this sile Clcan Ch k'�WV, Grinder pump, elr,.): " ('% .���+ �C, <br />lNl�erc vdas the device inst211ed (oeneral description, attach m�p)? ��v+� , � � F? ��`- � �' � <br />VJ�is there any other s�tiver or storm drainag� work r,nmp!etetl in conjunction ivilh the 8WD work7 Is so please desr.ribe: <br />Installation Checklist: <br />Are all downspouls and site drainage tlisconnected (rom upsiream of lhr. BWD'1 �j'Yes [_] No Commenl : �' <br />°�C�-'LY� C' �F1L y� <br />Does QWD positioning meets minimum slope roquiremenl of >1%? �Yes �_� No CommeNs: �_ < < <br />Gan 81Nd he pulled out for inspection antl maintenanr,e a(ter loosenir.g thumb screw? � Yes ❑ No <br />Is �WD locked into ihe proper posilicn and thumb sr,re�v tighlened7 � Yes ❑ No <br />Cirr.le lhe BNJD cover: irrigalion cov '((andw scape are���aHic load 6earin� cover (drive sur(ace) / ac ,ess hafch (building) <br />�r;r�s prope�ty ovdner sho�am Ihe locafon of I—h ns•'lalled BN�D? � Yes [� No Comments: � I< <'���� <br />Pioperty Owner's 5iqnature: ���'� ��._--- Date: � 1.8 �4 !. � _�-- <br />Inslaller'S Signature' _, ` ' ����ti � �fl`_� ---- Date: � � �'"- �l—�---. <br />it„�,,,.,i�i� � 1 Mnnday, Scptemf�or 15, 7014 <br />