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i <br /> -. ��������� ����,�r������ ���6�� �� ; <br /> � � - ���������,����� �s�����.n�� e��� <br /> .��.,�.,_�.._�_�.,__-- <br /> __���._,._�.�.���..���� <br /> mstallation Company f��ame and Contacf Info: MvP.n �l �� � <br /> _—___ yMh„� �a�����-�6� � <br /> Dafe Bada�,�aier Preveniion tlevice(DN,�D?was Insialled: ��� � � � � '-""'-`-'— ! <br /> Inslallaiion Proper��Owner h�ame and Gontact Inio: '��,� �ate this iorm was completed: S�-.7-v-1� � <br /> Property�ddress: `�UI � lI;'��W �?L---��I(1 - 1=dJ,ic�S��zL�1� � <br /> _ '._'-�--•-._..� <br /> I're-Insl.Allation Inspoc[ion Ghecl<Iis4: ------� � <br /> All iiems musl be checiced'Yes'in oroer for a BU�D to be considered for insl�7ation <br /> Is there a basemeni or level oi the house fhat is at or near assumed sewer main elevaiion?(�Yes ❑h�o ! <br /> ,4re lhere nxfures in ihe house locaied belov:�the upstream sev;ermanhole rim elovanon7�Yes ❑ (Vo � <br /> Is ihe side se���er currently UA�PR07FCT�D irom see�er bac�ups(doos not heve a BIND installed)?�]Yes ❑No � <br /> Site Insper6on Cher.l;list: <br /> A��ifems must be checked Nes'beiore inspecfion!s r.onsidered complefe <br /> lVas sitls sev�er N inspecied from building to sev,�er maln? �Yes ❑IVo Condilion: <br /> Does side serrer have ai least 1%slo =' M{� �v� <br /> p�nom the building to set���er main7 �1'es ❑�o Describe: � <br /> I;ave all building sev✓er drain connacfions fo the side setver been idenfifi�d and located? <br /> Have all prapeiy sior�ro tlralnage connectlons io ihe side se�ver been identifietl and located��yl es❑No i <br /> Has propeiry 6een evaluaied ior drainage defici2ncies vaiih findings communicated to propety ovmer? [�`Y�s n Plo <br /> tnstallaiion Ue'rail,: <br /> 14�hai{ype and brand ot DWD was i�stalled at ihis sile(Clean Checlt BINV,Grintler puntp, etc.)� /� � <br /> V��hera�:�as ihe device Inslalled(generel desaipilon,ahach map)? c,c (� •e�L `f,f.� ��-e_oFc � <br /> -- � ,Y__._.�.�-�_ ,�_.�.��__..- __.. i <br /> _"�-------�------�-- <br /> �lJas there any othe�setveror siorm drainage wotic com leled in conjunclinn�wih the BN�D Work? Is so please describe.' E <br /> - -- — ---- � --� i <br /> Installa[ionCheddlst: ��--- ----- — ` -----•—•---•-- ; <br /> Fve ail dovunspouls and siie drainage disconnected from ups(ream of ihe DWD? [�jyey (�R�o Commenfst ! <br /> [)oes BWD posifioning meets minimum slope rayuiremenf of>1ib? �t]Yes ❑fJo Commenfs: <br /> Can BVt�D be pulletl oul for inspeo�ion end mainienance afier luosenin��Ihumb screvd? Yes ` ' <br /> Is 8WD lor.!ced into the proper�osition and ihmnh screu�tightened7 ��Yes ❑No � ��o ` <br /> CirGe tne LN�U co�� _i��o�r91or-(�antlscape area)I iraffic laad bearing cover(drive surfaco)I access hefch(buildin�} + <br /> !'ras property o�.vner shoi•m ihe locatfan oi ihe inslalled RVJD7 �Yes ❑No Commenis� I <br /> � <br /> I <br /> P�op�ry Owner's Signature: _�_ Dutc <br /> InsfallersSigoature:__�iT�:>`�`��� _ ; � <br /> __.__,___._...�.._�...___....._. Date: �-.2v -� S� <br /> i <br /> Itevlsion:2 i i <br /> D.�nndzy,Septem6er 15,7.014 <br />