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Installation Company name and Contact info: Moe,,, � <br /> Date Backwater Prevention device(BWD)was; <br /> installed; Date This form was completed: <br /> Installation Propert�,alner Name and Contact Info: N <br /> Property Address: vZ i 1-7 U.';� , S�3 i 3 acs <br /> lyre-it slalIatian Inspec,don Checklist: <br /> All items must be checked`Yes'in order for a BIND is be considered <br /> is there a basement or levoi Of the house that is at or near assumed sewer main on <br /> Are there fixtures in the house located below the upstream sewer manelevation? Yes No <br /> Is the side sewer currently UNPROTECTED from sewer backups(does no-,have elevation?a IVD i�YeS?❑ a <br /> Sita Inspection checklist; installed)? Yes ❑Na <br /> All items must be checked Yes'before inspection Is considered com le' <br /> Was Side sewer TV inspected from buildinger main?to selyd pre <br /> Does side sewer have at least i%slope from the Yes ❑NO Condition: v d <br /> buildin to seIlermain-. S� s <br /> Have all building sewer drain connections to the side sewer been identified a located? No Describe: <br /> Have all property storm drainage connections to tie side sewer bee Yes ❑No c <br /> } <br /> Has property been evaluated for drainage deficiencies with findings communicated to cried? irEs ❑ o <br /> property owner? <br /> tnstaflacian Details: Yes Ej- iqo - <br /> What type and brand of BWD was installed at this site(Clean Check SVVV Grin at , z <br /> .where was the device installed T nder pump,.�c.}. <br /> {general descripldon,attach map}? <br /> a. <br /> l <br /> Was there any other sewer or storm drainage work completed in conjunction with the BWD work? Is solease de • <br /> p scribe; l <br /> Installation checlzlisf: <br /> Are all downspouts and site drainage disconnected from upstream of the BWD? <br /> Does BIND positioning meets minimum slope requirement �> /o.o Yes ° comments; <br /> nt Qi ? o COIi ments: <br /> Can BVVD be pulled out for inspection and maintenance after loosening thumb screw? - <br /> Q.,.,.. � <br /> Is BWD locked intoe proper position and thumb screw tihtened? <br /> Crcle.the-BWD cover;irrigation cover(landscape area)/trafFc load b�n9 es,..v{�info . <br /> Was property owner shown the location of the installed BWD? 2Yes cover(drive surface)1 access hatch(building} <br /> ❑�Q Comments: <br /> Property Owners Signature: <br /> Date: <br /> lnatalier's Signature: —f' - <br /> Date: <br /> aevislon:Z <br /> IUlonday,September IS,2014 <br />