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9NTSTALLATMN CEJECK ST <br /> 3 <br /> } <br /> instafiafion Com an <br /> P Y Name and Contact Info_ Moe,-, P(. <br /> fate BackwaterPrevention device Bi -7(—U —��� <br /> ( d}was installed. pate This form was completed: 3 3 r- f <br /> Installation Propett}�Owner Name and Contact into: <br /> Jal Properly Address: f 7v U. <br /> Pre-Installation ins eciaorah►ecklist: <br /> All items must be checlfad'Yes'in orderfor a BWD to be considered;orinslatiatio <br /> Is there a basement or level pi the house that's afi or near assumed sewer main elevai o►�.� <br /> j� <br /> tQ Yes iVo <br /> Are there Mures in the <br /> is the side 110140 located below the upstream sewer manhole rim elevation? ; Y <br /> sewer currentlY UNPROTECTED from sewer backups(does not have a Bk/VD inz t it ex No <br /> mite l€�s�ec:ticr���ecklisb; ed)? �yes ❑talo <br /> Ali hams must be checked Yes'ba,ore inspection!s considered comp/ere fi <br /> i. <br /> W2,;side server R/inspected from building to setr4t <br /> er main? <br /> Does side sewer ha �Yes 0 No Condition: b-Z)u L f'U� <br /> ve a:least 9°�o siapa from the building to main? <br /> Halle all building sewer drain connections to the side sewrier been iden� [ Yes No Describe: <br /> ad and located? ®"Yes ❑ No <br /> Have 211 prOPer`iy Stol*m drainage Connections to the side Sewer been ideritified and located? <br /> Has properbf been evaivatmd for drainage deficiencies with findings communicated ow Yes 'E No <br /> Irtssaldaii©n Details. to icated to properly owner? ]ye5 I_! N10 <br /> What Type and brand of BWD was installed at this site(Clean Check BWV, Grinder pump, etc. : (e, c. <br /> Where was rhe device insiailed(general descriptlon,attach map)? t-/C!)f <br /> r. <br /> Was there any Other sewer Or storm dr8in$g2 work completed in conjunction with the BWD work? Is so please describe: <br /> installa'don fieclslis4; <br /> Are all downspouts and site drainage disconnected from upstream of the BWD? W Yea LJ NO Comments: <br /> Does BIAID positioning meets minimum slope requirernent or j lfl. �—______ I <br /> Can Dvt�?he pulled out for inspection and maintenance o ? S ❑NO COMMGnis; t <br /> after loosening thumb screw? F Yes ❑Na <br /> Is RWD locked into the propar position and thumb screw tightened? EfYes ❑ No <br /> Circa the IIRiD cov e landscape area)I traffic load Hearing cover(drive surface I access hatch <br /> Was property Owner shown the location of the installed BVVD? Yes i�io Comments: } arch{building} ?: <br /> �] ❑ F <br /> Properly Owner's Signature <br /> Date: <br /> Installer's Signature: -- Date: 3 --7/- (6 <br /> Revision:2 <br /> MOt'daY,September is,2014 <br />