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BACKWATER PREVEt�TION DEVICE FINAL <br />INSTALLATION CHECKLIST <br />Ins!alla: or Company N�me acd Contacl Info: .___ <br />Date Backv;aler Prevention devi�e (BIND) �vas irstalied: <br />Inslallat!on Property� Oe:ner Naine and Contact In(o: S <br />P�operiyAdtlnas� i��� � ����//�/ <br />Pre•Installation Inspection Checklist: <br />Date this'o�m .eas cumFieted <br />N! ilems must Ce cl�eclred 'Vas' �n ordet for a BbVD to be cons�dered �or installalion <br />Is (here a basemen; or le:�l o` the house Ihat is at or near assumed see:er main elevalicn"? i%Yes ( No <br />Are there futures in ihc hcuse located Lelc:� the upslream see:er manhole rim elevaticn? �Yes ❑ Nc <br />Is Ihe sde sev:er currentiy UNPROTECTED (ror� se��:er backups (does not have a BVl'D �nsta'�led)?� Yes � Nc <br />Site Inspection CliecklisL <br />qil ifems mus� oe c^ecked 'Yes' be/ore inspection is considered r,ample!e <br />1'las side se�ver i V msper,ted from building to ser:er main? �j Yes C No Conoit�on. <br />Does s'�de sewer have a; lea<_t ?°% slope from the bu�ldiny to se�aer main? ,�Yes ^i No Des:,nbe: ____ ___ <br />Have a'I buiiding se�ver drain connections to lhe side sewer been identified and located7 �1'es ❑ No <br />I ia��e aU property storm drainage connections lo IL•e side se.ver been idenlified and localed? �l'es [� No <br />-� <br />H�,s pre, erty been evaluated (or draina,ye deficiencies vrilh findings communir.ated to preperty o:,ner? � Yes _ 1 No <br />Installation Details: �� �� <br />l'Jrat tyoe antl brand of BWD was instailed at this site (Clean Check BVVV. Grinder pump, etc l: �i�}�j��1fZL��- <br />'A4,��re �•:as the device installed (general description, atlach map)7 <br />': ;�as'here anv o!her sewer or slorm dra�in4ag�e� �vork completed in conjunction v�ilh lhe Bl�'f) work7 Is �o pleasn desr.rihe _ <br />-- --- -- �v �-, -- — — <br />Installalion Ch�cklist: <br />Arc ail dnvanspn��.i!s and site droinage dsconnected frnm upstream of �he BWD7 ��Yes ❑ No Comm�;nts <br />L)oe, �WD posit�anmg mr.ets minimum slepe requirement of >1%? �Yes ❑ No Comments� <br />Gan BWD be pulletl out tcr insp�r:l,on and mainlenance after loosenin,�g l{humb screw? �j Yes ❑ IJc <br />I� 8WD locked into the prcper pnsition and thumb scre�v Ughtened? ,�I Yes ❑ No <br />C��rcle the BIND r,over: Irrigation cover (landscape area) l lral(ic load bearing cover (drive surface) I access halch (b�.,�l�i'n;�; <br />EVas prcperty owner shovm the IocaUen of the installed B�ND7�1'es ❑ No Commenls: <br />�� � � / <br />�- Property 0�•+ner's Signalure __�< _ �� �Date: "� �i�. �- <br />�� <br />- - Installer's Signature: — _ ��— Daie: �_r_� _� S <br />q�_,i,.in�� � _ Fnday. Septem6er L2, 201d <br />