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BACKWATER PREVENTfON DEVICE FINAL
<br />fNST/aLLATiON CHECKLIST
<br />his�allation Company tJ,3mr. ,�n�i (:unl,:cl inlu' ( �i '( � :' ,� "_ . _.� �' �-
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<br />Dale Backta�aler Prevenlion duvice (H,MU) v✓,iti iic;l:ilh�d �' -`� �/ i U;ili� Ibi; lui�n v:,c,,:,u,q,l��lc�l /-> - J�
<br />Ins:allation Property Ovener Na!m; and Cnntnr,l hdu �/ij�'El- �.' �.�� -i.? /'�- /
<br />Proaer(yAddress: / �l Z _i..i 'r7• --- -- -
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<br />Pre•Insfallation Inspection Chr.cklisC
<br />Allitems tnusl be cher.ked 'Ycs' (r� n�de� !or a BWIJ !o bi� r.nn.�ii/r,���d !ni insl;dl,ihr;ri
<br />Is there a basement or Ievel of Ihc liouse Ihal is ;il ur ncar;issuinr.d scwr.r nriin cicvaliun"� ��� Ycs ( � P!n
<br />Nre Ihere fixlures in Ihe l�ouse lor:;ited belo�v Ihe upsiream sey;c:r ncmholr. nm elr.vnlion'/ ��"S',�s � � �ry�
<br />Is Ihe side sewer r.urren(ly U��PROTECTED Irom sr,�;�er bar.kups {docs nnl h;ive ;i f3WD nislalled) � ��Yc�; � � fJo
<br />Site Inspection Checklist
<br />AUilems niust be r.Aecked'Ycs' birlore insper.Gon is considcred cun�plcic
<br />14�as side se�ver TV inspecled from huilding in sr.wcr m;irn? ���j ycs � � No (;��ii�{�i;,�;i.
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<br />Does side sr,wer have al Icasl 1"/„ slope from �he buildinq In scvnar m,im'? ��-f Yc:; � � No Descrilic.
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<br />Have all building sevrei drahi conneclinns lo �I�e side sr.K��;r ber;n �����i�lifir,d and Ir,r,;dr.d'� ��-�'y�; �( N��
<br />Have all properfy stonn drainagc coni�er.lions lo Ihe side s!wvcr hr.cn idenlifiitd ;u�d Irn:;ah:dY � �f Yr.s j� Nu
<br />Hzs property been evalu:ited lor d�ain��yc clefir,iencics tvilh findinqs cnir�muni;::iled lu p�upcity ntvnr.�'> � ��y���: I I �J„
<br />Installation Details:
<br />VVhal lype and brand of �WD Has inslaifed al fhis sde (Cican Chr.r,k R�A�V, Giinder pump, •:Ir, )/`[.r,irv�( ()�;� G�
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<br />lNherc was fhe device insfalled (gr.nr.r71 descriplion�llach m�ap)'� _ j_�_ r, ), ',,- b �,l„�i-/-'r�FL--c
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<br />V��as lhere any olher ser�er or sform drain,ige work compleleil in conjunr,hun �ailh Ihe f3VJD wurk`I Is su ple:isr. describa:
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<br />Installation Checklisl —
<br />Are all downspouts and sile drahiage discunnec�ed froni u��sircaiu ul Ihe HWp'� ��y,;,; � � ��„ r:,�i�i��i„�il,;
<br />Does F3LND po:;ilion�ng nu:cls rninnniun siopc reyuiremr.nl ��f >i'%,.� �,"(yi,,; � � Ni� (:�!iiiiii�,�iL;
<br />Can RWD he puiled nul Ini uispecliun und mnmlonancc aflcr lousening Ilwnd�;� �rril � �jY�": � i Nu
<br />!s Ol��l) lor.ked inln Ihc pi��per pusilwn ;ind (hwnb scretv liyhlened'� ���j Yi��. � ��o
<br />Cirelc Ihe B�ND r.ovec inigafion r.uvci (I,indsc��>e �u �) /tra(fir, lorid licrwnq cnvr; (d�ivc s�uLir.u)l;ir.cc:��: h ilrli (I�uiIJm�U
<br />4'Jas ptnpcily nwnr.r shu:vn Ihr, localiun ol Ihe ii�slalled BVJD1 ��: � Ycti � � Nn ('nnnncnL;:
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<br />Ins;i!f:•i�.:;i��n:�l�u�, /2t,(..1��� �� ( .._�`: `"` _... ir.n. / - ��"
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