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i <br /> ; <br /> '� BACKWATER PREV�NTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> i <br /> — , <br /> � ' <br /> Inslaila�ion Company Name and Co�tact Info: _ ,��'�'1 i�' rLL'S �L-l��1�f, iA!(��,T�!v ( ; <br /> Oate �ack�valer Pre��ention device (B44�D)was installed: � �� _ �5 _Date Ihis form e:as completed: ���S /-� I <br /> � <br /> nsl:al alion P,operty Q�me�Name ano Contacl Info: �� a-tE �$�vf(-N�� _^_ � <br /> E��o���ry nddrPss: _1���/c��//�.�- _���.r.�� _ : <br /> Pre•Installation Inspection Checklist: ' <br /> i+>itenu musl be checked'Yes'in ader(or a BV✓D to Le consrdered for installation • <br /> I�: �nere a basement r,r level ot ine hous� that is at or near assumed se�:�er main eie�daticn? I�s ❑ No � <br /> �i�e ;here fx(ures in ih�hcuse located I:�Io�v th�:upsUeam setve�manhole rim elevation? _�s �� Nn <br /> Is�he si�E SB1^er currently UNPROTECTED from sevrer hackups(does r,ot have a BW� installed)? ["� ❑ No <br /> Site Inspectian Checklist: ; <br /> rl�l i!ems irtust L•e r.hecked'Yes'be%re irspr.ction is considered co , ete -- <br /> t^;:i� side se:ve�N insper,led from huilding to sewer main? � Yes ❑ No Co ition ___ <br /> l)ces side se��rer iiave at Icast 1�7�slope from lhe buiidiny(o sca;er rt�ain? 'es ;_.��o Des rb��_ i <br /> Have a�l lwilding se��aer drain connpcGons to ihe side setver been ident�iied and located? � es (] tvo <br /> Hsve all pronerty storm drainage connections to�ne side sevrer been identifed and located? ��es � No <br /> i'as proue�ty be^n evalualed tor drainaae daficienci�s wilh tindinys communicated to proe2rty o���ner? __ 'es j.j No <br /> Insta!ialivn Details: <br /> ;VP,��t lype a;ri branrj oi D11�D was installed at this si c(Clean Gheck f31NV�rinder pump,efc.):��1r+�s-�c lL <br /> . <br /> ;^;��erc�,�as;he device instalied(,yeneral descnp�ion, ,ta;;h ma ? __/4T/� .�_ '�'� P�<_/Gc i _ _ <br /> ':1'as iheie any uther se�aer or storm droinage edork complefed in conjunction�vith tfie [ilh�D e�ork? Is so please desctil�e: _Jl,��- <br /> Installatiun Checklist: ' <br /> /�re al cio��msp�uts�md sile drainage disconnecletl from upstream of lha B D? �_ es ❑ No Commen�s: __ _. <br /> D�es BVdD positioning meels minimum slopc «�quiremenl of>1"/0? � Yes �_� No �C.,o�ir.•ments:_ _ _ __ <br /> Ca��, aWD be pulied ouf tor inspection and mainienance afler loosening f�h�u �screw? ��Y e.s IJ No <br /> Is flbVD1 !oc � � ' preper osilion and I�umh scre�v 6,yhtened? [_V Yes �] No <br /> ;:ur.la f z k b '!�vP.i gation �over jlandsr.ape area � Iraific load h ,ring c over (drive suriace)I access hatr,h (building) ; <br /> 1'vas :xopr.� y ,; ,�.r sh�„vn the locafion o`lhe insla'led BN�D? [__ Yes [ ] No Commenls:____ _ <br /> PropeRy Oe;r.ers Siysature:_�'J-_-��f,�i���`-2„r2__--- Date: 1-/�7—/�� <br /> Ir.staller's 5ignalurc _�.���_,� ___� __ /�S�c� Date:� � ��15 <br /> — � --- ----- <br /> ke�vision ? ._ ivlor�o�ay, Septembei 15, 2014 � <br /> I <br />