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BACKWATER PREVENTION DEVICE FINAL <br />INSTALLATION CHECKLIST <br />� , <br />�ns(�1�3'ir�(:a-ra�in;I:�:n��e�ncC�ntacllnfo:_.���1'1j'�rLI�S L•L�r1ni51A!��� �J�:i . _ <br />T" � <br />Uafe Eiac��vater Pred:;rPor device (BVdD) �:�as u,sfa7e i�.���71�j�-- D�Ie Ihis (c�m :cas comFlefed� �...�_ �_ <br />is!allalron Prbperty O:sner IJc,r�e a^d Contacl Inio � LLZitg�..�N ��� ^�uN 1 O 5��'r?�i�'�1La5o1.22� l <br />::rrp.�RyAdUress _Z�-i�?�1_�,��tLL�te�i�i __f�lr��_�vt(E_I_i--�`—��� �i�2.0 <br />-�---- - <br />�'re•Ir��allation Inspection Checklist <br />'��� �fems ciust ca cr:er:�ed 'ycs' �n o; oer (c! a EI�dD to be considered for rnstallation <br />Is t� ere a basemenl cr leael uf ti�;; Fouse ;L•a; �s at cr near assmned se:ver main elevation7 L" i(_I Vo <br />`•r�� •he�e 6r,t���es in the I�ouse'�c;a?ed bclo:v tha cpslream seenr manhole rim elevalion? �-'!fs ❑ Wc <br />_.�d•�:�-r:er c.rr�:;�ir ��A"=ROTE�TEC `rc�^ �ci:cr!'�a_k�.ps (do�s no; bave a BWD insta9ed)'� [_t-}kes! � ��o <br />Site hisuection Chec,klist <br />�.,'d!'ii5 0':;5; �;C Ci1P�:�oC 'V'p,c' hnrC!t'.I/iSPa�=1��'� i5 !.'DIl$iC�BB� C�D�lllp�2iB <br />'.`,as s�de se:eer N!es�;ected froo�� Luild ng ;c see:cr ma�n? [✓1, 'es ❑ No Cordition. �ti r'n �� <br />U,es side sewzr have al least 1; siope iram the building to sewer main7 �t�?'es ❑ No Descrbe: __ _ <br />!��ve all buiid�na scr�er dr2in connections to the side se�ver been i�enlified znd lecated? (l�}'�es L� No <br />� lave all preperty sform drainage connections lo the s�de se�ver been identifed and located"� ��-�1 s(-] Nc <br />� ias property beL�i eval�,ialed for drainage deficiencies �vith findiny:; commun�cated tc property ovmer'> (�� � 1 fJ�-: <br />Installation Detalis: <br />.'i'i>.�! (; pe and f;rantl of BIh�D was Installed at this sile (Clean Chc::F. B;^; V, Griirder p�,i np, e(c:): (_��/liJ Lj1�� �C.. __ <br />' t�,� c���as the tlevr�c u•�slalied (general descrip�ion, attach mou)'' --I��ru�_ H'tZ�?,c,i�� -- --- ----. <br />::as Uieie any other se�ver or storm !+rainage c+ork�c�mpleled �n conjundion wilh ihe L�WD eroik'� Is sn ��Iease desr,r,L�e. <br />D��� – <br />_� --- - —� – - -- — ---- <br />Inslallation ChecklisC <br />;��u: all dr�•;n;puuts and sile drainaye disr.unnecled Irom ups!ream of the (�l�Vf)� �i��Ycs ❑ No Con�ir�vd= <br />!!c��; fJ1'dD postinning meets mirnmum slope requirement oi>1°�o? �_ es L� ho Cemments' <br />C an BWD he pullod cut tor inspeclion and mainienance aRer loosening Ihumb scre�.v? �Y�� �;_ � 1Co <br />Is pWD �ucked into the prnper ppsiliun anci Ihumb scre�v ligl•�tene�l7 �Yos ❑ No <br />G�cb� ihe 9N'D cover. i rigaticn cover (landscaae �rea)' Iraffir.load bearing�cover (drive su�facr,; !�3cc•��; I����Ir,i, ;I���ii:;1�r�;� <br />dda� ��roperty owner sho�vn lhe location � Ihe i�sia'ladf N�C? '�� No Commems' <br />�� <br />r'� y;d.y�J�vnus$ipnalurn� ; �iii �'� -__ � � ':Uale�-��2���7 - <br />insialier'; Sig�alurr', --- —�'�<��"-=v= ---, ------ — Dc:;� --t �-(3�� �-� _-- — <br />!t���d�s�.�r. . 1 `,.tn:i;ltv �i�:•tnribr..]S.;O::i <br />