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! <br /> �/�CKVIIATER PREVEfVTION ��VICE FINAL ; <br /> �, INSTALLATION CHEC6�(LIST ! <br /> ; <br /> i <br /> �'►'1�'(`i cccrl ��� �c� � °.�",d� . c����-l', L 1_G ( <br /> r, � ���� „r�� 1�,,.. ���� a����. <br /> Installation Company Name and Contact info:T1?C��j_[_C-��Z,i,1.;t� 1��� � � <br /> D: �9ack�vater PreveNion device(13WD)was inslalled:_jp�� _Date ihis torm�vas compieted:��j�f,�. � <br /> F�d__��--- ' � <br /> Installalion Property Owner Name�nd Conlact Info:_ ���- "—J�-��--'��'' <br /> PropertyAddress: 1�.� _ �X��d---_A':Ln�-�ty� s.c--���+- � <br /> � <br /> Pre•Instaliation Inspection Checklist: <br /> All items must be checked'Yer'in nrder lrn a �WD lo be ronsidered for installation � <br /> Is lhere a hasemenl or Icvcl of Ihe house Ihal is at or near assumed se�ver main elevalion?�'es [J No <br /> A«�there iixtures in U�e hnuse lor.ated below Ihe upstream sewer m,anho�e rim eleva!ion? ��Yes ❑ No ' <br /> Is ihe�idn sewer r.urrenUy UNPROTECTFD irom sevrer backups ju„�:r�ot have a RN1U instailr.d)? ��es (_ � No ; <br /> Site Inspertion Checklist: j <br /> l�II ifems r,hust be c,�^r,ked'Ves'before inspection is considered comp!ete <br /> Was side sevrer TV inspr.cted .'�nm huiidirg to sewer main? r�Ycs [� No Cnndilion: __ __�'��k�. -- <br /> Does side sev�er have at Ieast 1%sicne(rom ihe huildiny to sewer main? ��Yes ❑ No Descnbe:_ ___ _ � <br /> Have all building sev�er drain conner.6ons. lo lhe side sewcr been identilie, and localed% [�Yes �J No <br /> I iave all property Storm drainaye conneUions to Ihe side sr.�:�er been idenLhF;i and located7 ��(es �_� No , <br /> Has property been evalualeri for tlrainar,e de(ir.iencies with findings c:ommunicated to property oi�mer� �Yes � � No , <br /> Installalion Delails: � � /) <br /> �Nhat type and hrand o( [�N�D was in;.�lled at Ihis sife(Gr.an Check BWV, Grinder pump,etr,.): ��;��_ (,,,�C'�1X <br /> Wlinrc: �+�as I�iu�ev�ca insl�illrcl (�r:n�:r��l�csciiF�lic��i,att:ich map)7 , "C'_ _G£��C�':��{-��--�-^�Ei�-�-- . <br /> Was Piue any oR�e�sewer or slorm drainage work r.ompleled in conjunction erdh Ihe E�lNO work7 Is so please descnbe: _ ; <br /> _ _ _ f�1clYl l> _ ------ ' <br /> , <br /> Installalion Chr.ckhst• � <br /> Arr,dl down��nuls and sdc drainage disr,onnected (rnm upsiream of thc BVJ�? ���Yes �] Nn Comment,' __ ; <br /> �nes BVJD positionin9 mcels minimum slope requirement of >1'%? �j�.)Yes ( � No Cnmrnenls __ _ <br /> Can BWU Gr. pullyd aitl for Insp�r.tiun and rriaintenance alier laosening ihumh scre�•i! (}�YE's L J N� � I <br /> Is f�WD Inr.ked inlo Ihe�rpper position and thumb screw IigMened7 �Yes �_, M�� I <br /> Circle Ihe BWD co �irfiyatiun giv�:i �ndscape area) I,rallic load bearing cov��r(drive surfac:e)1 ace;ess hatch (butlding) <br /> - f-�"-- - <br /> 'Jdas property owner s o�'n Ihe lucation ol Ihe mstallr.d RWD? �Yes �_� No Cornmenls ________ _____ _. <br /> Prt�pr.rty Owner's Signalum -- �_ � � ��; _ - ----. ..------ �atc. _,�4' ���j -- — <br /> � ----- < <br /> Inslaller's Siynalme. �- " �-, J�� D�lc._ � _l�/�_ <br /> _--- --- <br /> _ — i <br /> kovi;��nn 7 1 f�id;ry. ��'picmboi II, JOIA <br />