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, <br /> � <br /> ��������C ����6�?�`�S�'� ���/8�� �@�If�►�. � <br /> rv' ���`�'k�P�.r'�1�S�E�9 ��f�����a�`�p. ; <br /> � <br /> •---�.__....__,—�.a_ <br /> �a���� _ � <br /> fns!allaGon Com an� ���^�.�"^ � �. <br /> p /N2me znd Contad info: MOen �(y,,,�,.•,, " <br /> D:fe Bcch;'c�Ef P2V � L��f 7�'U ���'U � <br /> en'r'onee�ice{Blh'p)�;�asfislap,d: IU- .�-� r —p"~ - <br /> Insiallaiion Prcper'y 0�•�ner�Jame and Coniact Info: 7i �aie ihs f�rm�vas c�mpletzd: �U-__�-_i r <br /> �4.cb_� �fL�. '�',� r" y.7.� b� N <br /> Preper;ykcdrpss:�`lU � V� t�rv ;'L �--_ . <br /> Pre•InstallaBon InspecUon Checkiist: --- � <br /> All irems Tust 6e checked'Yes'in order;ora BUJD fo be cnnsrdered iorinstallzlion <br /> is tnar2 a Laseme,�,o�leael ef ii e house lhei is at or near arumed sev,�er main ele��at:on7�s,l 1'es ❑Mo <br /> Are;ner nxrures in ihe hou:e lo;zied belo�v the upsfrea��se�;;sr manhc!e nm ele��ation7�Yes ❑ ��o <br /> Is the side setse;current'y U�NPROTECTED from sawer bactups(does rot ha��e a BVJD ins�iied}7 (�J y� C�o <br /> Site Inspecoon Checklisf: <br /> N!,'�tisms musf be checked Yas'bsiore inspec6o,�!s r,onsidered ecmpiete <br /> :'Ja�siCe seti��er N inspered rem bui'ding tn se�;ret;r2in7 <br /> 1�085 SId9 SBR'E(hZVB Zi�B85t �%5'G �; I �YeS ❑I�o Co�idition: C;n�'�_��� <br /> F-'rom the bui,ding �o sev,2r main? �Yes ❑i�o p�cr'te: <br /> Nave ali bui',ding se�:er drain conn=_ctions to the side sewer Ceen i�en56ed and Icc2!ed? (�yes ❑ No <br /> iiave all p�p�er,y sterm drelnage cor�neciions io tr,e sice set:�er bsen i�enu�ied and Iccaled? �1 Yes ❑Plo <br /> Has Yro�erfy been evaivaied for drair,age denc;encie;wi,n findiras communicated to property oe,mar? (�Yes [; i,!n <br /> Inst�lla�ion Deiails �' <br /> �'r1',=!t},pe and brar,d of BVVD t;�as inst�0ed at Utis site(Gean Chack Bl^.N, Grinder oump,etc,): G�e.. �L__� t� <br /> !'/herc ti��as th.e device Instal;ed(generai descripllon,afi2Ch map)? h4 c � �< L <br /> ' -.s.�.,,.,_-.., <br /> blc=s thera any othar seti,�e�or stom drain1lvp�k��mP�ete in con�unction vnt�,he 9UJD work? Is so please dascribe: <br /> -- - --- /'✓/�.___ — <br /> insia(la6on C�tecl;llst: T — <br /> A;e ail doe;nspouls and site drainege disccnnected irom upstream o((he BIQ'D? ��]Yes ❑�o Comments: � <br /> Dr�es BV�rD positloning meets minimum s!epe requiremenf of>9°l0? �Yes ❑�io Cemrenis: <br /> Can P,1ND be pulletl eut tor irspeciion and mainienance afier looseniny ihumb screvdl �j Yes ❑P!o <br /> Is f'W�lo�:lced into ine p�� ��ti`and thumb scre:v tiahtened7 �j Yes ❑�o <br /> Cir�:le the 6�ND cover i�rn aU� on c,oyat(�ndscape area�ltraffic load bearing cover(drive sudac4)1 access hatch(buildir�g) <br /> lNa;prcpariy otvner sho�,m the icca6on of the inslalled BWD'1 (�J Yes ❑No Co�nmenls� <br /> Pror�erty Gwner's Signature: Date: <br /> lnsfaller's Signature:�� _ Date;J �- � � I i <br /> Revislon:2 1 Nionday,Septemher 15,2014 <br />