Laserfiche WebLink
�ACi�CV1i�iTER PREVERTION �EVICE FINAL <br />� INSTA�LATION CHECKLIS�' <br />fnstallation Company Name and CoMact Info: 1"I u�� J�� •"` y"t/ I� S �� �% � 1� U <br />Date BacM��ater F�evenUon device (BINO) �vas inslalled: >' � <br />Insfallation Property O�vner IJame and Contact Info: Sv l�i <br />PropertyAddreys: ��II � 12ot,1�-e,�-c.,ll�- <br />�ate this form ��ras comaleted: �— �y-1.5� <br />Pre•Installation Inspection Checkiist: <br />AN items must be checked'Yes' in order for a 8l"✓D 10 be considered Ior installalion <br />� <br />Is there a basement or level of the house that is at or near assumetl se�.�er main eleva�an? � Yes ❑ �o <br />Are lhere Fixtures in the hcuse iocaled belo�v the upstream se«er manf�ole rim elevation? Ch'lYes �] No <br />Is the sde sev�er currently UNPROTECTED Lom se�•��er back�ps (does not have a B1h�D installed)? � Yes ❑ I�o <br />Site Inspection Checkf.5t: <br />AU rtems must be checked 'Yes' befo�e inspec�io,o is cauiderad con�plete <br />4Vas side sewer TV inspected irom builtling to seerar main? [�j�Yes ❑ No <br />CondiCon: SU,�c- �1,� (�S <br />Dees side seeler nave at least t°� slope from fhe 6uilding fo se�ver main? jJ Yes 0 No Descri6e: _ <br />Have ail building se��,er drain connecL�ns to the side sewer been identifed znd located? �Yes ❑ ��o <br />Nave 21i propery storm drainage connections to the side sewer been identified and Iocaledl �"Yes ❑ No <br />Has property heen evalualed for drainage deficiencies wiih findings communicated to property ownar? �"Yes ❑ No <br />installation Detail�s: <br />INhat type and brand of BVJD �ti�as insfalled at this site (Clean Chec; BWV, Grinder pump, etc.): C�-.� (� ��-5 �Z� <br />l4'here �;�as the device installed (general descnption, attach map)7 'l� n b�- i�:�-c.n_ -� s ��� �> <br />_� ..'L l�l«:J �I,�z��- <br />Was ther� any other S�v+er or storm drainage v�ork completed in conjunction �vith the BWD �vork? Is so please tlescribe: _ <br />Installation Checklist: <br />Are all do�vnspouts and site drainaye disconnecled from upstream of the BWD? �Yes ❑ No Comments: <br />Does Bl4�D oositioning meets ntinimum slope requiremenl 0(>1%? k� Yes ❑ No Commenis: <br />Cen 84�'� be pulled oul for inspection and maintenance afler loosening Ihumb scre�v?�Xey—[}Na <br />Is BWD locked inlo the proper posiGon and thumb screw tighlened? ��ese-No <br />° - �,--- <br />Circle ihe BVJD cover. ' i�� �couei{landscape area) I ira(fic load bearing ce��er (drve sudace)t�ccess halch_ uilding) <br />Was property ovrner shown the localion of the installed BWD? [k�Yes ❑ No Comments: <br />Property O�vner's Signalure: <br />Oale: <br />Insfallers Signature: �2is� ��zt-- Date: `J - � 5 " � -S � <br />Revision: 2 1 fvlonday, Se,;tember 15, 2014 <br />