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11i05/29i5 02:CIPM 4?i:5366E7 tAaPLF GF.UUF RV PAGE 01/05 <br />11i09�?O15 T:x] Pb F a25JJ54J70 Cnmptell's PnmDlns, [nc m Ooo2i000E <br />BACKWATER PREVENTION DEVICE FINAL <br />INSTALLATION CHECKLIS7 <br />ns;aUctin�� Campany �IlaT.e a�d Con;act Info: '` ���� C�_ ��. u'h i��1( 1 ��� <br />Cete Oadcwater PrevehGen cevicq (BWD) was iqyt�lled: �1-1-1- IS' p�te thi: forn vraa completetl; i. "�'{"1 � <br />�ns�euacon ProYc;rf p�mer Name and Conta�i Ir,fo: Rc�(�E2T �n2p —�p� <br />A� w� '•-1L5-1`i3-s74g <br />Fro�erty Aedress: �fi219 W t`'fmoi� �� ���� 4� �, h �^ � <br />Pre•InstallaGon lnsp <br />A'1 dsms m,us' be cho <br />Is �Cere s hesemen( o <br />A.T Ihere fix��,ee in !h <br />�a the s'de s�er�r curti <br />5ito Inapectlon Chec <br />lJl iferr,s must Ce cn� <br />iN2s SidO 6@'b'ff T�� inl <br />�ces side sav.ar nzvz <br />N.�ve all hu�lding se�tie <br />r.�ve an prop:rty slom <br />-�as ProFerty he^-n eva <br />Installation Oetails: <br />'Nhnl lype and brand o <br />VJherb� o�,�he d0vi:a <br />V` � <br />��'��s ihere a; �y other se <br />_ N Q:_ <br />Installation Checklist; <br />:tion Chacklist: <br />ed 'Yas' ir croor �r e 8'Np to be consiaered (orirstella:ion �,/� <br />�ve: ot Ne house inal 19 at or near assumed s�v,-�r main eievnEcn��I� �Y ❑ No <br />hcuse !c.^.eted Deio�v lh,e upn;raam se•x�r manlole rim 21:vation? �}'�g �,yo <br />Uy UNPROTECTE� 6om se,+er backups (dces not hnve a dWn irswllee)? ee ❑ No <br />:... <br />d'Y�S' b@(Oro ins,r,r.tN.OR 15 Ccnsidared COmp;efe <br />cied trom Dvi�ds�g lc se�Nef main? � Yes ��1 Nc Candi(ion: C`Z�� <br />!east 14; s!oFe tmm tho tuiltling to Sower main? ee [] Np pas�be; � <br />':�in ronnec;!on; to the eide sewgf tcron ident!tled 'and Icrated? [�c U N�— <br />a�nege cpnnechons to the side sew>r been iaen;iTiai ene ir,cated7 �,�es C] ,��o . <br />ted fer dminage deric:enCies wi�h findings ccmmunicatetl to propzrry cwne�'? Yes ❑ N. <br />�h� was instxlletl ;; th;e she � C� � <br />��eck�81N, Gtirder pump. ctc.J: C.�.�-� ('i'�� ' <br />lu��eo qonara� r.escrip;icn, s;tar.�ti map)7 Fr�.vsr- �p� � ��� <br />. � , <br />r or slarm drainage wotk corpletea in conjur,ction wltn Ihe BWD work7 Is so please d— �S�;jp,�; <br />Arr, a�� doansComs 0rd Ite drninnge disconnocled tr�T upshenm o( the OWa7 es I 1 No Commanls: <br />Uo�,u BWD pos,f�aiing eels mimmum siopc reGulremenl 0!>7°,? "—" <br />� � _ es (� No CAOtmsnW' <br />Can l3VJD be pullvd uut or insFeciion n�G ma;nlonance after Icosenin thu b saew. ~~—^ <br />Is E3�VU lodced inp� r.er'�,c�p�,�-! ,, 9 '�F �7 No <br />�;��•- k�SC eu tghtened7 YNs ❑ Ido <br />Cirle Iho BW[) c� Fi; , cover (;andscape ar�aj i ife bad bearin cover drive sudaCe / e <br />VJas ��mpEriy own2f Sho'Nn L�e Iccat�on of t n ins � g � ��ess halch (buifd�rA) <br />� � tafled B1^1D. cs [),yo Commeal�: <br />Pro;em� Ovmer's Signelur` e� <br />Insta;la�s Si4naNre; Y <br />Nevieicn: 2 <br />� <br />Da:o: !/� J --/ <br />�Uale: __,� � f <br />Mnn�lay, September ]5, 2014 <br />