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i <br /> � <br /> BACKWATER PREVENTION D�VICE FINAL . <br /> INSTALLATION CHECKLIST ' <br /> , <br /> � <br /> : <br /> � <br /> Installalion Company Name and Contact Info����i(,r��l�'� /CM� r'+� i <br /> Date Backwater Prevention de��ice (BIND)n�as installed:�'' ��� y Date this form u�as completed:.�—" '07�' i <br /> I <br /> Instaliation Property O�timer Name and Contact Info:�iut�' }'P.q� '�._ � <br /> � � �� I_, I <br /> ProperiyAddress: ',����?7 Vl1�CIN0�- �� '� <br /> Pre•Insfallation Inspection Checklist: I <br /> All items must be checked'Yes'rn order Ior a BVJD to be considered lor installation � <br /> Is there a basement ur Icvel oi the house Ihat is at or near assumed sewer main elevation?�Yes ❑No �I <br /> Are Ihere fixtures in the house localed belovr the upstream sev,�er manhole rim eievation?�Yes ❑ No ; <br /> Is the side sewer currenlly UNPROTECTED from se�ti�er backups(does not have a BWD inslalled)?(�Yes ❑ No <br /> Site Inspection Checkilst: ! <br /> All items must be checked'Yes'before inspecfion is considered complete ' <br /> U1'as side se�t�er TV inspected trom building to se�ver main? �'Yes ❑No Condition: ���� � <br /> 9 <br /> Does side sewer have at least 1%sibpe froiii the building to sewer main? �Yes ❑No Describe: � <br /> Have all building se�ver drain oonnections to the side sewer been identified and located? �Yes ❑No <br /> Have all property storm drainage connections to the side se�ver been identified and located? �Yes ❑��� . <br /> Has property been evaluated for drainaye deficiencies with findings communicated fo prope�y a��ner? �Yes ❑No <br /> I�stallation Details: � 02 � ! <br /> What lype and hrand oi BIND was installed al lhis sil (Clean Check �INV,Gn'n�er pump, c.): (`�� �eci � <br /> \4'here was ihe device instailed(general description,attach ma�)? «CK R � ��ti � '� ; <br /> � <br /> " � i <br /> N1as lhere any other sewer or storm drainage work compleled in conjunction tivifh the BWD�vork?Is so p�ease descrihe: IvC� <br /> i <br /> Installation Checklist: � <br /> Are all dovanspouts and site drainage disconnectetl from upstream o(the BIND? �Yes ❑ No Gommenis: � <br /> Does BWD posilioning meets minimum slope requirement of>1%? �Yes ❑ No Comments: � <br /> Can BWD �e pulled out for inspection and maintenance ai�er loosening lhumb screvr? (�'fes ❑No � <br /> Is 41ND locked i�to the proper position antl thumb __ �v tightened? �Ycs �]No : <br /> Circle Ihe �!JD r.over. imgation cov r(landscape area !traffio load bearing cover(drive surface)I access hatch(building) � <br /> 1Nas pwperiy owner sho�vn 1he location o mstalled BWD? �'Yes ❑ �o Commen(s: , <br /> �1 i <br /> Properiy Owner's Sign lu : —� Date: �`'—������ i <br /> Inslaller's Signslure: _ �,1 1a Ylt�� Date: �-' �>1L— � <br /> Revision:2 �v \ 1 Monday,Seplemhcr I5, 2014 i <br />