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BACKWATER PRF_VENI t'ON DEVICE FINAL. <br />Q, Il STAL.I_ATiON CHECKLIST <br />AilylltriLC <br />Installation Company Name and Contact Info* <br />.,> <br />Date Backwater Prevention device (BIND) was installed: (0 15 Date this form was completed:( 11i_ <br />Installation Property Owner Name and Contact Info.e� <br />Property Address: 1 >_ j__Cn �n � &.>-e , F 0I <br />Pre -Installation Inspection Checklist: <br />All items must be checked 'Yes' in order fora BWD to be considered for installation <br />Is there abasement or level of the house that is at or near assumed sewer main elevation? MYes ❑ No <br />Are there fixtures in the house located below the upstream sewer manhole rim elevation? R Yes ❑ No <br />Is the side sewer currently UNPROTECTED from sewer backups (does not have a BIND installed)? Epes ❑ No <br />Site Inspection Checklist: <br />All items must be checked 'Yes' before inspection is considered complete <br />Was side sewer TV inspected from building to sewer main? IF Yes ❑ No Condition C 00d <br />Does side sewer have at least 1% slope from the building to sewer main? Yes ❑ No Describe: <br />Have all building sewer drain connections to the side sewer been identified and located? [�5 Yes ❑ No <br />Have all property storm drainage connections to the side sewer been identified and located? y(� Yes ❑ No <br />Has property been evaluated for drainage deficiencies with findings communicated to property owner? [S'Yes ❑ No <br />Installation Details: � c <br />What type anddbrand of 81ND was installed at this site (Clean Check BINV, Grinder pump, etc.): C; <br />Where was the device installed (general description, attach map)? 5� e a * ,-1l hrid 4 S 4' <br />Was there any other sewer or storm drainage work completed in conjunction with the BWD work? Is so please describe: — <br />�rf3'L P <br />Installation Checklist: <br />Are all downspouts and site drainage disconnected from upstream of the BWD? [ Yes ❑ No Comments: <br />Does BWD positioning meets minimum slope requirement of >1%? 1� Yes ❑ No Comments: <br />Can BWD be pulled out for inspection and maintenance after loosening thumbscrew? [� Yes ❑ No <br />Is BWD locked into the �_roper position and thumbscrew tightened? V Yes ❑ No <br />Circle the BWD covd : irrigation cover lalydscape area) I traffic load bearing cover (drive surface) / access hatch (building) <br />Was property owner shown the location <br />cation he installed MID? Ij Nes ❑ No Comments: <br />Property Owner's Signature: <br />Installer's Signature: <br />Dale: 311 4 115 <br />Date: <br />Revision: 2 w 1 Friday, September 12, 2014 <br />