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�� BACKWATER PREVENTION DEVICE FINR�L <br />- INSTALLATION CHECKLIST <br />�.,_� <br />� <br />Ins;ailation Company Name and Conlact In(o. �, ���'\ E�i'� �i L� �L�i�1n�51�L(� �ti (. _ <br />7 <br />U i��; 9: ckv;ater Prever;ion device (BWD) was inslalled:_,j���j__, Date this form �vas complet2d:_ <br />ins(ailation Propert, O��mer Name and Contacl Into: _�1��� lo iSl�_ _______ <br />ProaeRy Addres�. `2Z31 /�� �,�.�a �j A�e �v_�r;'E'# V—�i __ <br />Pre-Installation inspection Checklist: <br />%,'I �fems rr.usf be chec6ed 'Yes' i�� order Ior �3 BIND to be corsrdered (or instalfation <br />s tiiere a basemen( or level of the house that is at or near assumetl sewer main elevation? L Y'e� �� � uo <br />;v�; 9,ere f�x(a;es in ihe house located belo�v ih�c upslream se.ver ma�h��e nm elevation? [��es ❑ tJo <br />�. .:�, . <br />s!� e s�d�� se;:er currently U�PROTECTED irom se�•rer backups (dces no! haee a 8!^.'C rs(al edp �� Yes j_ ��J� <br />Site Insoection Checklist: <br />-„i ifems niust be r,hecksd 'Yes' be(ore inspeclrnn rs considered comp: �;� <br />r: �s side sevler N inspec!ed (rom building to se'�ver main'? �e; '_ _' tCo ��rci!:c� __ <br />C x;; side sc�.ser have al Ieast 1% slcpe from the ouilding to se�ver main7 I+ Yes [j No Ueseribe. __, <br />':, e all Luiltling sev,er dra�n connections to the side se�ver heen idenfified and loca(ed? [] Yes [] No <br />I�s; � all property slorm drainage conneclions to il��e side se��rer been idenli`led 2nd located? i i�l l'�s ❑, /Ku <br />f�'�e p;opeily been evai:iale : lo� �:ira;ra�e tleticiencies':�,�Pi i n�n�qs �cnu,�.�n c,l�d lo cro;,e��y� o�;:n_r % �,�/ Y��� [' h;o <br />I�islallation Details: <br />:�i��ai I��pe and hr�nd qf iibi�f) �va� inshi'a�d t:t �h�s sile ;C��ear Ch ��:•; i3'::'1r G�ridAr p.imn, �;�: �_ C Iva_.� _c /��� k_ <br />�i�:l'e't? l'�r�S I�19 (��.VIC° IflSlklli^i; i jL'I1P';1� d'.tiC!i�)IIOfI "�.(?C�l fll"3{l�' _I�,�.P_!+�'�11�L'_ ��nr.�, �( � y"^ LtgLLt:�_� _ <br />i <br />{�-.�u5�_.r3nn.��zX�fu!<,ly .�� a'�%y� «.±cl�afonn -- — <br />':r:�� (I,�crc an�� olher se�ver or storm <br />Installalion Cher.klist: <br />�vork coinpleted in conjunction aa�th ihr. l3lND e:ork? Is so please dr.sr,nt�e r,1'r� <br />��i a�l do�:n;;pouls ani: site dr�inaye discnnnecled (iom upstrr.am ot the BUJD7 [✓j�Yes ❑ No Commenls' <br />I:.;;s [3VdD posil�oning meets minimum slope reGuiremenf of >1°�6? ��s [l No Commenls. <br />�'_u�� pW� be pulled oul for inspection and rnainl��nance after loosening Ihumf; screw7 [,� �_] p;o <br />s i?!'�'D IocF;ed imo the proper position and lhumb scre�v tiyhtened? � Yes ❑ No <br />C�i;:ie the BV�'D �over �a.r::x�^r flandscape area)1 tra(fic loatl b aring cover (drive surface) ! access ha!,:h �t�urdina� <br />,S._�,.o_� co�/ee <br />b:'as property ovmer sho�.tin the Iccatron of th^nstalled BWD? �_t Yr,s U No Commenls ___ _ <br />F'rp�ity Ovmer's Signature� <br />Insial!er's Signature: <br />t.;�.ti;�i, , <br />�Dale: � Z.�.� � �`S— <br />-- —�— — <br />_ Date: 3 �G ' � — - -- <br />i,ionday, ceo;eriher 15. ?OL1 <br />