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BACKWATER PREVENTION DEVICE FINAL � <br /> E,• INSTALLATION CHECKLIST � <br /> � <br /> _ i <br /> Installation Con•,pany Name antl Contact Info:� . � �.L . . �(1W S 1 IC-(��(1✓V �- ! <br /> Date Backwaler Prevention device(BIND)was installed: . ' � / Dale Ihis (orm was completed: � �",L� i <br /> n i <br /> Inslallation Prcperty Owner Name and Contact I�fo: ��.5��)/�'LC �Jtl�Gq- � <br /> Property Address rll�i l�`� 1 V\4���.1�� I <br /> � <br /> Pre-Installation Inspection Checklisl: i <br /> All items nwsf be checked'Yes'in or9er lor a 8WD fo be considered(or instalfafion + <br /> Is there a basemenl or level ot Ihe house lhat is at or near assumed sewer main elevation7�Yes ❑No � <br /> Are there 6xtures in ihe house Iocatetl below the upslream see�er manhole rim elevation?�/]Yes ❑No � <br /> Is ihe side sewer cunenUy UNPROTECTED irom sewer 6ack.ns(does not have a BWD installed)?�]Yes ❑ No ; <br /> Site Inspection Checkli<,t: i <br /> A!1 items rnust be check�:d'Yes'6etore inspection is considered complete i <br /> �,Nas side sewer TV inspected irom building to sewer main7 �Yes ❑No Condition: ; <br /> Does side se;ve•have at least t%slope (rom the building to se�ver main? �Yes ❑ No Desciibe: � <br /> � <br /> Have all building see:er drain connections to the side sewer been identified and located? �Yes ❑No j <br /> Hai�e all propeRy slorm drainage conneclions to Ihe side se�ver been identified and located7 ,�Yes ❑ No � <br /> Has proporly been evaluated for drainage deficiencies���ith findings communicaled to property o�.vner7 �Yes ❑ No ' <br /> Installation Details: �t� ��� ��,('� � <br /> What type and brand of BVVD eJas installed at Ihis site(Clean Check BINV, Grinder pump,etcJ: (�SlJ1��+�- � <br /> Where was the device insiall d(general descrip6on, altach map)� � ' _ � <br /> r - � . ,�1 � <br /> Was lhere any ofher se�ver or s rm dr inage v�or comple,e m conjunction wilh the BVJ work7ls so please describe:_ � <br /> _ .���,�1l��r�i/�-i�!)�1.)�, ;( <br /> Installation Checklist: ' f <br /> Are all dmNnspouts and site drai7age disconnecled from upslream of the Bl��D7 �es ❑No CommeNs: ' <br /> Does BWD positiening meeis minimum slope requirement o(>1%? ,�]Yes ❑ No Comments: � <br /> Can BWD be pulled out(or inspeclion and maintenance aHer loosening lhumb screw? �Yes ❑No S1 <br /> Is BW�J locked into Ihe E•roper posilicn and thumb scre�v lightened? �Yes ❑No I <br /> Circle Ihe BIND cover imgation cover(landscape area)I traffic load bearing cover(drive surface)I access hatch (building) � <br /> Was property ovmer shown the loca6on of the inslalled BWD? �]Yes ❑No Commenls: S <br /> � � <br /> n / � i <br /> Property Owner's Signature: V�� Date: S � S <br /> � �-, � <br /> Inslaller's Signalure: � Date: ,�1 ' ��1 � ,� f <br /> Revision: 2 � Friday, Septzmbcr 12, 2014 i <br /> � <br /> i <br />