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BACKWATER PREVENTION DEVICE FINAL <br /> INSTALLATION CHECKLIST <br /> Instailation Company Name and Contact Info: � n"�1�f���(Y x='^��- �-�-y�S y�93 <br /> Date 82ckr+ater Prevention tlevice(BIND)�1�as insta!led: '�' � Date this form v�as completed:s��� <br /> M���� �S ��� �1ul��ll� ���� �� 1 �a a�� I <br /> Inslallation Prooerty�Oioner Nam�2nd Conlact In`o: / <br /> Propeity Address:�1 f�.[.� ��� <br /> Pre•Installation Inspection Checklist: <br /> All iterns must be checked'Yes'in order ior a BIND b be considered tor installation <br /> Is tnere a basement or leval of the house that is at or near assumed sewer main efevation? Yes ❑No <br /> Aie there fixtures in ihe house located belo.v the upsUeam se�:�er manhole rim elevation7 1'es ❑ o <br /> Is the side sevrer currently UNPROTECTED irom see�er bac<ups(does not have a B1'dD installed)?�Yes ❑No <br /> Site Inspection Checklist: <br /> All items must be checked'Ves'be(ore ins ectian is conside!ed c m lete . <br /> P p <br /> UJas side see+er TV inspected from building to se�;�er main? �Yes ❑No� Condition-� <br /> Does side sewer have at!east i%slope from the building t6 seaer m0in? d Yes ❑ No escribe: <br /> Hzve all building seerer drain connections to the side se�+�er Eeen identlfied and lur,aled? [�1'e ❑No <br /> Have ali property slorrn tlrainage connections to the side se�aer been identified and localed? �Yes �No <br /> Has property been evalua,ed for drainage de(iciencies with findings communicafetl to property o�:�ner7 Yes ❑ No <br /> Installation Details: (7„���, <br /> N�hat type and 6rend of BV�+D was installed at this sit (Clean Che BI�JV,Grinder pump,etc.): I"� 1 <br /> INhere mas Ihe devir.e installed(gereral descriptien, attac map)? 'u . `t� 'L� , <br /> 14'as Ihnre arry other se�ver or storm drainage v,rork completed in conjunclion wifh ihe Bl4'D�a�oik? Is so please desciibe:N� <br /> Installation Checklist: <br /> Arc all downspouts and si(e drainage disconner,letl irom upsUeam o(if e BWD? Yes ❑No Commenis: <br /> Docs BWD positioning meets minimum slope requiremenl of>t%? Yes ��No �C/pnments: <br /> Can BVJD be puiled out tor inspection antl maintenance afier loosening+humb screw? fU/ Yes ❑No <br /> I s �W D l o c k e d into the pro per position and thumb screw 1i c�htened? l J Yes �] No <br /> Circle the BIN�cover: irrigalion cover(landscape area) traffir,load earing cover(drive surface) ccess hatch(buildino� <br /> 1�'as property ownar shown Ihe location of the inst Iled BN�D7 Yes ❑No Commenis: _ <br /> C% S l�- ►S <br /> Property Oa�ner's 5ignatur Date: � <br /> � , �Inslaller's Signalure: 1,,e i Date: �6' <br /> Revision: 2 1 Monday,Septemf�er 15,2014 <br />