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<br />BACKWATER PREVEN I ION Di:VICE FINAL
<br />INST-ALLATION CI-�ECKI_IS�1-
<br />If15I7II:3(10!1 COITipan;� tJan�e and Cnnlacl Inf�S: io�v��+7_'C�V� 1�r.N�`�.ldx�`rf?= yZ�_ �"�Z_- 7Y�.`-�.
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<br />Date Back�valer PrevenUon device (�WD) w„s in>;�. i'I.��I ��1'�� ( 5 I Ld� Ilu, l;�.0 � w,e, �:�n�p!„I� d�i f ZL// 5
<br />Installatiun Prcpc�iy O�.rcr Name and Cor..a�t Ir(;�7�r''��S ���Z�"�� C-
<br />ProperlyAddress: 2`iZ�� ����� t'r•'c.���
<br />Pre-Installation Inspection Checklist:
<br />.4f1;terns rnitst 6e chcckad 'Yes' in order lor a f3VVD to D;r r,r;m;d: �; ��d (: �.� :n: �, ��L �t���r;
<br />Is lherc a basemr.�t or levcl o( �he house tha� is ai or n��ar a_;sun�,r.J s��rrnr mam _� ev,ilion�� � �•j Yn::
<br />tire tltere fixtures in ihe house Iccated bela�v fhe upsLeam sew,�r rianl�n;�� rim elev:3l�on'? �'� Yc�; �
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<br />IS �he side set�er u;rreefly UP:PROT[CTL=f) (rom ;c�ccr b:�: l.r,p:; j�'c�:s m�l h:iva � Rl'JD �r„I,i'Ic�,l; •' ✓� 1'cs � � PJu
<br />Site Inspe�tion Chcr.klist:
<br />A�! items rnus? be rlreckco 'Yes' bei;�e inspr.r.lrcr� is r,onssiered ru�npfe'e
<br />1�'2s s�cie srwcr 1V inspecled Irom buiiding to see;ar niain'� � h1'e:. �; No l;on�1!Gcm _ _ _--
<br />Docs side se�a�er have af Icast 1°/a slope �ro;n lhe bw!ding I�� se�,vcr �nain7 �'j Yes I � ���� Desr.nf�c ._----
<br />Have a!I buildinq sercr drain cnnnectlons to ihe sidc sr.;:cr br,cn ideniificd ard Incr3fed7 ��� Ycs � � Nu
<br />Haee all property slorm tlrainage connections to the sidc sewcr bcr.n id��idified and lor.�ilcd? �'j Yr.:; �� No
<br />Has properiy Leen evaluated for dra:nage deficiencies v;dh Und:nys cuimnunicalr.d lu �uup:�iry o�.sn���'� I� 1'r.:; � I tdo
<br />Inslallation Details:
<br />L1'hal (;�pe and bruid of LiN'D was installed al lhis sile (Clr.,in Clie,;k lill'V, (;rndrr ��wnp, c�c )�i,ri�1��! C'I �ti �- �
<br />bVhere v;as Ihe devir.c inslallr.d (general tlescription, ailaeh map)'% U�'T�f� '� �l�
<br />Was lhere any uiher se�ver ur storm drain:ige work r.omplr.fed in conjunr.lion ���ilh lhe NN�D �+�nrk7 Is �;u ple,�sr, descnbe: _
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<br />Installafion ChecklisL
<br />Are all dow�is ouls and siic driina� e disconnectr.d (rn,n u�sheam nl Ihe f��N(1� � �
<br />P J I I•f Ycs i� Vo Cnumir.niti' ._.__
<br />Does [31���U posilinning mecls minimum slope requucmr.nl ol > 1'i�? ��'�'es �.I IJo (;ununeniti , __ _.___
<br />C�n Rllq) bc pullyd riul fui mspecirun and ma:nicn�inr.c,illc� I;,nsr:niuq Ihumli :;r.n:w' ��Y�, ; � � Nu
<br />Is IiWD Ir�r.4c�l mlo ILe praper pnsition and (humb scretv Iiqhlrncd7 ��rl'cs � � No
<br />Cirdc the !3N'D covci: irrinalion covcr (landsc,�p'r, arcn) /lnflir load Iu:�inng cuvcr (driv�r :,nii: u:c) I;ic��cs:, h�ilch (Luddin��)
<br />b'ia; �irupc�lyovnu�i shav:n Iheloc�(ion � f� m;L�JI::{I BWI)'� ,�{���ts � � Na Conun��ul,
<br />Pro;n:rly Utvncr':� Si,pc�luu�
<br />Insl:�!I��i �. t;���n.itn��
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