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BACKWATER PREVENTION DEVICE FINAL <br />E„ INSTALLATION CHECKLIST <br />�.,�f �,, �tZ 201�- �f�- �llq� <br />Installalion Company Name and Conlact Info:r�"�'^ _�L J�o � at�orm e�as comp!eted: s I�`��� <br />Da:e Bac{�,ater Pre�ention de nce (BIND) �tias insta11ed:� ,/S� - <br />liut2ltation P��per'�y Os,�ner tVame an6 Co�tact Inf6� �J��^'� kr� <br />PropertyAddress: ��-idS f�e;c}(�.tc(�2�C- �1%�_ <br />Pre•Installation inspection Checklist: <br />All items must ne checl<ed 'Yes' in oide � a BVJD to 6e considered for installation <br />Is thera a basement or level o( the hr .,e ihat is at or near assumed sev�er main ele��ation? Yes ❑ No <br />Are fhere 5xtures in ihe house loca;ed belor+ the upstream se�ver manhole rim elevation7 Yes ❑��o <br />Is the side sewer currently� UNPROTECTEd from serrer backups (does not have a BI�JD inst�l!ed)? � Yes ❑ No <br />Site Inspection Checkiist: I <br />tif� ifer�s must bs cF,ecked 'Yes' be%re inspection is consiaered Compiete <br />�Nas side seerer TV inspected from building to se�r�er main? �J Yes ❑ IJo ondiiion: <br />Does side sewer have at Ieast 1°h slope from the L•uilding to se�ver maln? �les ❑ Wo OescriBe: <br />Have all building se�r.er drain connections'e the side ser+er heen identified and located? � Yes ❑ No <br />Have a!I property storm drainage cannections to the side sevrer 6een idenfified antl located? JYes � No <br />Has property been evaluated for drainage deficiencies rvith findings communicated to properly ov:ner? 1'es ❑ No <br />Installation Details: D„ L �oQ��� <br />b'!'nat type antl brand et B�ND e+as installed at this sit (Clean Ch k BWV, Grinder pump, elc.): I`C- ,� n <br />_ I�GcD ��u�� Fn�� �V� <br />Udhera �:as ;�e�fevice msialled (gereral descripi���n, atla ap)? � <br />bVas Ihere anv other sewer or storm tlrainaoe �n�ork con,pleted in conjunction �vith the BV��D v+ork7 Is so please descrihe.� <br />Installation Checklist: <br />Arc a!I dovrrspouts and site drainage disconneeled from upstream ot ,h Bl4�D? ,_1 Yes ❑ No Commenis: <br />Does BWD positioning meets minimum stooe requirement of >1°�0? �Yes ❑ No Comments <br />C2n BN'D be pulletl oul for inspection and maintenance afler loosening humb screw? � Yes ❑ No <br />Is E3WD lor.'�ed info the proper positicn and th b�s �ee+ tightened? � Yes ❑ No <br />Circle Ihe BWD cover. irrigaUon cover 'landscape area f tra�ic loa ' bearing cover (drive suriace) ! access hatch (buildino) <br />�A'as property owner shovm lhe lo�ation o tne installed B�' . Ye ❑ No Comments: <br />Date:� � ���� <br />Pronerty Ovener's Signature� ' � <br />installer's Signalure: •�'1 � Dale: S' ( r�(r�7 _ <br />Revision: Z <br />��9onday, September 15, 2014 <br />