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1 <br /> 1 <br /> ���'(�;�l�T"�[; ��'tiL��FI� l�619�['�[�'��V�G�6ti <br /> � n �f�����-e`���� <br /> — i <br /> n i <br /> Prope�y Address:_( �OU I'1,�Ee.r �v+� � <br /> BI'dV in�ered by: L J�.��<�t�- Date [3WVwas Inspected: : ��13 � l0 arvt i <br /> 3�/ � — �lu<L ��r�.z(z„ > �,,� Vax � hl sY4 0� y,,sa� 4 <br /> � <br /> Inspection Checklist , <br /> Are all dotmspouts and site drai��age disconnecled from upslrezm of,he 9VN? ❑1'es [�No <br /> Commenls:�_�o}•,�S.nc+���,�yo����i�� - Sr�,wr/jrn•th,�fn� �. <br /> Dees BVJV positioning meels minimum slope requirement of>1°0? ❑ Yes ❑No � <br /> Comments: <br /> � <br /> Can B�i�'V be accessed for inspecfion and maintenanc�? ❑ Yes � No <br /> Czn BWV be secured inlo the proper posifion? ❑Yes �No E <br /> ! <br /> ';Vhere is the valve inst2l!ed(general descripfion,atlach map)1 I <br /> Is Ihe ins1211ed BL4N considered an 'approvetl'model by Ihz Gty of Everetl? ❑ Yes �No <br /> Lb'as prcperty ovmer shoem how lo inspecf and maintain Iheir 6WV? ❑ Yes ❑r�o rlA <br /> � .� <br /> Does this BWV require repair or replacement7 �j Yes ❑ No • . �, <br /> COf11R100�5: 1\eoon•p..+.t�[�� I�l.-1/ rrpin�a....�..'F 4-av ��.tl�C Vt-�VC_. It <br /> I <br /> _—_ I <br /> � <br /> � <br /> ( <br /> Inspeclor's Signzfure: pr��. _ I <br /> I <br /> � <br /> � <br /> i <br /> Revision� 2 Tuesday, Sep[ember 23, 2014�� ` <br /> I <br />