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i <br /> i <br /> BACKWATER PREVENTION DEVICE FINAL � <br /> t,• T INSTAI_LATION CHECKLIST i <br /> ; <br /> I <br /> Installaiion Company�ame and Contact Info:�eNrfc`� �KS�. l�J�«�`% y�j =J�T � r�� 5 ; <br /> � � � , <br /> Dale Backv�ater Prevenlion device (BIND)timas inslalled:�i-/� -�5 Da�e Ihis furm was r.ompleted:,� "���'�5 i <br /> Inslallation Property Ovmer IJame and Conlact Info: � tt�J�r{V C y����•� -3�__ 3��3 , <br /> n <br /> ��oPenynd�i��ss:. J`�(2_����----- --- — — � <br /> - - - � <br /> Pre•Installation Inspection Checklish � <br /> All�lems nu�st be checked'Yes'oi order/or a f3WD fo be r.oi�sidered It�r hislailalion ' <br /> ��/ i <br /> Is ihere a basement or tevel of ihe house Ihal is a(or ncar assumed sewar main elevation? �_`� Yes L]No � <br /> Aro lhere lixlures in Ihe house located heloiv ih�upsticam sewer manhnle rim elevalion?[�Yes �_ �Nn � <br /> Is Ihe side se�ver curren(ly UNPROTECTED(rum sewer backups(docs not have a �WD inslalled)? �✓jYes [)No � <br /> Sile Inspection Checkiist: � <br /> llfl rlems must be checked'Yes'Ue%re inspeclion is considered r.n i�plef e ' <br /> Was side sewer N inspeded from building lo sewer main? �es ❑No Condifion: _ � <br /> Does side sewer have al leasl 1%slope(rom the building to sewei main? ' Yes f:.l N� Desr.iihe: __ __ _ � <br /> Flave all building sewer drain r.onnections to Ihe sidr,sr.vier hr.en identilied and localed? ���Yes � ] No ± <br /> Havc all properiy sfaim dninagc cannections to Ihe sidr,sr.wer been idcnlified and lor.a�ed? L�(Ycs ❑�/Nu ; <br /> Has property ber.n evalualed(or drainage dr.(icienc:ies viilh lindings r.onimwiicaled Io prnperly ovaner') �"� Yes �_.]No � <br /> Inslallalion Oelails: �, I <br /> What type and brand nf 81ND was ins�alled at lhis si�e(Clr.an Check BWV, Grinder purnp, etc.) C'����^"N C If� �� _ I <br /> Where �,vas Ihe device urstaVed(yeneral desaiption,aflach map)? __�rtt-{ J r�7�C_�>C>�9_j�f��t-F -_- I <br /> . Wa, Iherr. nny other se�ver or slorm drainage work mmplr.(ed in conjunclion���ith thr. 13WD ti�ork?Is ;o plcase dr.sr.rihr.:_ i <br /> _ � ---.��_�_ _. --- --- _ ------ — — � <br /> Installation Cher,klisL• � <br /> r <br /> Are all down,�ouls and sde dr,iinru e disconnecled hom u�slieam o(ihe [1LNU? "rY�:s � <br /> I 1 r C. I J N�> Cnmmr.nis ._._ _ I <br /> Dor.s f3WD posdioning mcels minimum slopc icquiremeni n1 >1"/�? L"(�Ycs ❑No Commenls: ____ � <br /> C��n 8WD be pulled oul for inspeclion and mainlenance afler loosr.ning(humb screvr7 �"f Yes � �No ' <br /> Is[3WD lor,ked inlo fhe propei : ion and ihumb screw lighlenetl? [�Yes ❑ No � <br /> Circle Ihe 131ND cov r iriiqahon cov�r(landsr,ape air.a)/iralfic load br.aring r.�ver(dnve;urface)1 71f.CC5ti�131f.�1�IIUiI(IIOf]) k <br /> �--�= -- <br /> l4�as prop�ar�y o�vner shoedn Il�e I. � � �i oi Ihe in, alled BN�D� "�Y s n No Conmicnls _ � <br /> . �tii�i ,� / / . ! �—�5� <br /> Properiy Ovdner's ;ignalur: -- - -�_�_ ` .�" __ _ U��Ic ��_ --- - � <br /> " - - —� /- ' <br /> � , ' , <br /> Installei s Siqn,du�i� / �� � c_�./_i-C�-�"��-'- Dalr. �R---�� �>_ _ - --- i <br /> J --- ------- - i <br /> li��w•.um J i Mond.ry. '�r�ilrnihri I'�, 7�114 � <br /> I <br />