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� �T <br />BACKWATER PREVENTION DEVICE FINAL <br />INSTALLATION CFIECKLIST <br />Iestaliation Compan, Name and Coniact Info: _ L.�� rt� �-'h � LC � S i'L �!�1� IS �i���r; (. <br />Dafe Backvraler Prevention device (BIND) was insialled: i/ io ��__ Dale this form was completed: w <br />Inslsllafion Property Owner Name a�d Contact Inio: <br />Pruperty AAdress� <br />/od <br />Pre-Installation inspection Checklist: <br />AlHtems must 6e checked'Yes' in order (or a Bl4�U fo be considereti for instalfatron <br />Is ihere a h2sement or level of the house thal is at or near assumed sewer main elevation?� 1'es ❑ No <br />�re lhere fixtures in the hcuse ior,aled below the upsheam sewer manhole rim elevation? � Yes ❑ No <br />is !he s�de serrei cur�en!ly UNPROTECTED (rorn sev�er backups (does not have a BWD installed)? I�. Yes [' Nv <br />Site Inspecticn Checklist� <br />A9 i;ems ir,usl h,e cl�ecked'Yes' hefore inso�ction is cons�derea complete ' <br />1"ras side secrer N inspected irom building lo se�ver main? �f Yes ❑ No Condition: _��� _ <br />Dces side se�ti�er have at least 1% slope irom ihe building to sev,�er main'? �Yes ❑ No Describe: <br />Have �II Lwldirg Sewer drain connections lo the side sewer been identiiied and located? �-Yes ❑ No <br />H�we all property sform drainage conneclions to the side sewer 6een idenlified and located? �}-Yes ❑ N� <br />Nas propedy heen evalualed (or drainaae defidencies with �indings communicafetl to prooerty ovrrer'? C7Yr,s ❑ No <br />Installation Det�iils: <br />I��hat type and biand oi BN'U was installed al lhis sito (Clean Check DNN, Grinder pump, elc.): �.._ C�e� lt: <br />N'here �.vas Ihe davice installed (general descriplion, atlar.h map)'? i^-h(� �-9�t,.� __ _ <br />14�as there any other seaer or storm drainage work completed in conjunction u�ith Ihe BIND e,ork'? Is so please descnbe 1�,� <br />Installation Che�:klist: <br />Are all dovmspouts and site drainagu disconnected (rom upslrr,am of the �E3lNp7 �C Yes ❑ No Cominenis: ______ <br />Does 6N�D posdioniny meets minimum slope requirement oi>i%? �t�'Yes n No Commenis: <br />Can B�NU be pulled out for insper,lion and maintenance aller lousening Ihumb screw? �;r� [j No <br />Is E3�UD tocked in:o ihe proper posi�ion and ihumb scre�v lightened? 'es ❑ No <br />Cirde the B�VD cover. rrigation c�er Z t ndscape ar�Kc load bea 'ng covr,r (drive surface) / access halch (building) <br />1Nas property o�vner shown (he loca?ion ct Ihe instailed �WD? es ❑ No Commenis: <br />�� <br />P��peny O�vner's 5ig� atur : G� `� h`"�'�� 1 Dale: �/v i� <br />% �� � — <br />Ins(21Ier's Signature: _C � Date: � <br />_ ____ _ -- �l�Ld- <br />it���s�m,: z <br />Mondati�, Sep[ember 15, ZOl4 <br />