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�ACKWA�ER PREVENTfOI� [DEViCE FINAL <br />€N�T�1L���`IOf� CHECF(LlS�F <br />�nr.:ricc�r� �:��';-<<- � `��, <br />Irs;allation Company Name and Conlacf Info�..f ��•� �C.{=L9 �`�? �t` '►�+'=�`'i� �_� <br />Date Backe��ter Prevention device (�U��D) eaas installed,��� Date Ihis form �:�as <br />�z��, L <br />Instaliat' i ProGA�ty Orrner Name and Coniact Info: 1—�C'L�I.P !�.'C'.tt)ja���" — <br />P�o��r�yna��e55: ?�4-I�� f��;,kc-��� �., I,J�n�,g�,Q �'�'.��� <br />Pre-Installation Inspection Checklist: <br />All items must be checked 'Ves' in o�der for a BtND t. • be consrdered (or mstaflation <br />Is ?here z basemenl or level oi the house that is al or uear assumed ser�er main elevation? �'Yes ❑ No <br />Nre there fix:ures in tne house iocated beio�:� ihe ��H�s!roam sewer manho'c rim elevation? �1"es ❑ R�o <br />is tl�:e side se��,�er currenlly UNPROTECTED irem sewar backups (does nof have a BIND instal!ed)? �%Yes [j No <br />Site Inspection Checklist: <br />ti;l items musf be checked 'Yes' 6efae inspecGon is considered complete /� <br />!Ves side se�•rer 7U inspected f�om huilding to see+er main9 � Yes ❑ N� Condition l'�� <br />Does side sewer have at least 1°o slope irom Ihe building to sev�er main7 ;�(j Yes ❑ No DescriCe: _ <br />/' <br />H�ve ail building se�.�er drain conneclions to ihe side ser:er been identified and located? �Yes ❑ No <br />Ilave 211 property storm drainage connections to the side se�^er been idenlifed and located? �Yes ❑ No <br />Has oroperty been evaluated fur drainage deBciercies aith findings communicated to proper�y owner? �i Yes ❑ No <br />Installalion Details: <br />?�Uhat type and brznd of �UdD ivas installed at this sile (Clean Check 84UV, Grinder pump, etc.)� '���r„� <br />SVhere ia�as �he device installed (generai descriotion, atlach map)'? ,��-�[%'(__�j�a�k�L-1! 1.�—!"..�L���.— <br />y1'a; Iliere any oU�er se��+er or storm drainage tivork compleled �in� c�o�njunction �vith lhe �IND ��+ork? Is so please describe: <br />-- —�-v ci�2l)_ ---- -- <br />Installation Checklist: <br />Are all downspouts and site drainage discannected from upslream o( the BIrJD? [�Yes L� No Commenis: __ __ <br />Does f3lND positioning meets minimum slope requirement ot >1 %? (�LJ Yes ❑ No Commenis: <br />Can 9WD he pulletl out tor insper.linn antl maintenance alter looseniny Ihumb scretiv7 �Yes ❑ No <br />Is E3l^1D locked into ihe proper position and thurnb screw lightened� �1'es ❑ No <br />Circte O�e 8WD cov : riigatlon cover_(lalr scape area) I iraific load bearing cover (drive surface)1 access hatch (buildmg) <br />�A'as properly oedner shown the location o( the insialled BlND7 �� Yes ❑ No Comments <br />� / <br />Property Owner's SignaWre� � '� �ate:� � � J <br />_�� ' � Date: � <br />Installer's Signal�re. _ � G� � <br />Revision: ] 1 friday, Sepirmbcr ]7., 2014 <br />