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BACKVIIA7ER PREVENTION DEVICE FIN�4,L ; <br /> INSTALLA7ION CHECKLIST ; <br /> Installa6on Company Name and Ccntact i;iio: i�/���� i���/�T3/n�i ._. <br /> Date Back�vat�r Prevention device (BWD)was installed: 3,�T.�/i� Date this ferm�:as e�mpleted: 3 u � <br /> ins:allalion Prooe�y�Ov;r,�r Name and Contact Info: 3�e�r� �,'i��r+ � <br /> Propert/kddress: /�; i; /�r�i=�%,7 — <br /> Pre-Installation Inspection Checkiist: <br /> A!1 Ifems must be checked'Yes'in order for a BVJD to 6e considervd fo�instalfation <br /> Is tnere a basemsnt or levei of the house ihat is at or near assumed se�ver main e!evation?�] Yes ❑No <br /> Are there fatures in the house located belo:�Ih�upstream sativer manhole rim elevation?�f]Yes ❑No <br /> Is the side sevrer arzen�y UtJPR07ECTED frcro se�;�er b2ckups (does not have a 8'A'D ins:alled�l0 Yes ❑No <br /> Site Inspecllon Checklist; <br /> Afl ifems musf be checked`Yes'beforo rnspecL�on is considered complete <br /> �iJas side sewer N Irspected from building to se�ver main7 �(`j Yes ❑ No Condifion: <br /> Does side se�ver have ai leas;l% sbpe from the b�ilding to sevier main7 �j Yes ❑ No Describe: <br /> Have ali building sewer drain connections to the side se��rer been identified and located? �Yes ❑ No <br /> Have a�l property storm drainage connections to the side sewer been identified and located? �Yes ❑ No <br /> Has oroperfy been evaivated for drinage defciencies��1ith fndings commuricated to property owner7 �,1.Yes ❑ No <br /> Installation Details: <br /> 1Mhat type and brand of B�VD v�as inslalled at this s lean Check 1h Grinder pump,e;c.): <br /> �– --� <br /> Where:^ras ihe device installed(general descnption,atlach map)? Zi�r�T v-,.�r� <br /> tNas Ihere any other se�ver or storm drainag�v:ork completed in conjuncfion with ihe BIMD tvork?Is so please descrbe:_ ' <br /> �� — <br /> Installation Checklist: <br /> Are all downspouts and sile drainage disconnested irom upsfream of the BVJD? [�Yes ❑ Mo Comments: <br /> Does B�,VD positioning meets minimum slope requirement of>1%? �Yes ❑ Ne Comments: <br /> Can 11V��D be pulled oul for inspeclion and maintenance afler Ic,osening thumb screv�? U7 Yes ❑ No <br /> Is BVJD locked into the prop�r�osihon andlhum.b screw Gghtened7 �]Yes ❑ No <br /> Circle the BWD cover:d� a;ion cover[_andscape.2tpa}!�a#i�i load beanng cover(drive surface)I access hatch(buiiding) <br /> Was property owner shown the location of the installed BVJD?�Yes ❑ No Comments <br /> ��i��,� <br /> Property Owner's Sggylu � ' Dale:='�=, r�--f�--Z— <br /> Instaliers Signaf t�f�/ --- Date: 3�z7�/s' <br /> Revisicn: 2 1 Friday,September 12,2014 <br />