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Nov.13.2014 <br />� <br />� <br />12:08 PM <br />Ame�lo�n Seplb 6 Sewer <br />BACKWATER <br />insplia6on ComP�^Y Name anA CoMact <br />Date Backv�eter P�'�nUon devia (8W�) was Insla <br />�����a� p��y pwner Name and ConLct Info: <br />� <br />property Address. � <br />p�eaestNl�don lap�on Ch�cklNt: <br />AMitems mustM ��ed wec' in a^de�fora 8W0 <br />k theR a baeement a leve� of Uro howe tl�ai is al � <br />Are thete �s in tlie houac bca�d bebw Rie up <br />Is I�e side sawer cu're^NY UNPROTECTED hom s <br />SMo Inspution ClNokiiet <br />All Items musf ba �e�' ��m bnlding�to�+ <br />Was sak eawn TV hroPa ftom Ihe t <br />Doer side sewer ha�e at kast 11fi slop� <br />Have ep buiiding sewar drain connec�o^s to Iha sf <br />Nava aA auPertY �°rm drelnags connedions to M <br />Has propeAy been evaluated for dcainage de8cron <br />ineLll�tion DNa�� <br />What type and brend of BWD wae instalbd at Ihis <br />VJhere was ihe Oevice �n5lalle0 (geaera� Aeec�Ptl� <br />r-- <br />Was tMre any olher sewer or elam dninage work <br />Insteludon C�eckdsC <br />Ara all downspouls end ale drainege dis0000ecteC <br />Ooes BWD Dosnianlf� meets minimum alape RGuI <br />� gyyp pg p��led ou1 tor inspection end meiMen <br />�S gWD lacked into tlre proper posiGan and ihumb : <br />Cirtle the BWD eover. lrtigatloo wver pandscape : <br />Wes ProDe�Y �er sl+own tha <br />�property pwnera SigneWre: <br />Inalalhrs Sig�eWre: __._.� <br />Revision: Z <br />PAGE. 4/ 6 <br />025252•587� P.2 <br />�ION DEV�CE EINAL <br />CHECKLISY <br />�.C�.�d� i•'�,FF <br />[��z.: � , cr-l1.G �� <br />_ Date Ihh torm wes completed:�.(dt.l—'K— <br />I fotinsfaAetion <br />sewer ma�n elevation9 �Yes ❑ No <br />mhoie rim elevatlon7 (�Yes ❑ � <br />cec not hava a 9WD inclalledl� C�� ❑ No <br />d tomp�Me <br />�Yes ❑ N� CflndiOon: � <br />evrer ma(n? '� Yes ❑ No Desctlbe: <br />een ideatified and bcaled? � Yee ❑ No <br />et Oaen Weml�ed and locelad? � Yef ❑ No <br />�dings commuaha�ed to DroD�h 01'�h � Ve� ❑ No <br />, �� Qiiedc BVYV, Gdnder pump, etc.): �V <br />�ep)? <br />y�; Byyp wrirll) Is so pleeee de9cnbe: — <br />�am of �he BW07 � Yee ❑ No Camments: <br />1E6q � Yes ❑ � Commenls: �— <br />� e�ng mumti urew7 JB Yee ❑ No <br />�ic� �v� a r+o <br />bad oearin0 �� (drive aurface) ! ecaess hatch (EUUdln9) <br />� �Yas ❑ No Commenls: <br />' ; Dele: �� �� / <br />�Dete:.�L� — <br />i <br />� Md�y. Septem►K 3i.1D1A <br />