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<br /> "� � BAt�KWATER PREVENTION DEVICE FINAL
<br /> �;��� INSTALLATION i'CHECKLIST �
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<br /> Ins�alletinn Company Name anr,' f'�^tac! In'o _,��_ ��1_��LL�S �C �r11i5 I� !;� �L ( E
<br /> Ua1e E3ackw2ter Preven!inn dev��; (B�1D ��as installed: r �. /--
<br /> � � � � ��!/��-� _. Uate (his form was wmpleled 1c/ I � s ,
<br /> Installahcn Property Owner Na�nc and Contact Info. �� � � '- � �
<br /> =SF n,�� s �_1,� �_,,:,-�y} �
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<br /> �'�upert)�Adtlfess: , � �_..__ �_r_�f_il i���!'i:�—�L /ri r i �— �
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<br /> Pre•Installation Inspection Checklist: � � ,
<br /> A:;de;ns must b^chec�ed 'Ve�'m r,rder lur a BWD fe be considereo�or insfaNa6on ' I
<br /> Is!here a basemen!o�I�vcl r,f the house that is at or near assumr,A se��er main eievatiai�U� �
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<br /> ��.rc Iheie fixtures in the house or,aled bclow the upsircam sewer manh�ole rim e'evation� Ye, �J N� �
<br /> s Ihe s�de sov�er currenlly UNPR01EC7[D from sek�er backups (dees�cot have a DVCD mstalle;7�7 L��s l J ��� �
<br /> Site Inspection Checklist: ,
<br /> Ai��lems musf br.r,r,eckod 'Yes'belorr, inspecfion�s cnnsrdered co le;e '
<br /> Was side sewer N mspecled from buildmg to sewer main� �� Yes [] No C ntlillon: �
<br /> Dces side sewcr have al least 1}o slope(rom t�e builtl ng to se��er ma�n'� � Ycs L] No f7 cn0e '
<br /> �iave all hudd�ng sewer drain connections to Ihe s,de sewer been dentdieJ and located? I
<br /> I _ Yes � ] No
<br /> 11ave aU proGerty slorm drainage connections lo Ihe si4e sewer heen iden6lied anA iocafed? (_ Yes [] No �
<br /> lias prnperty been evalsateA for drainage dehr,�encies wilh findings cummunicated to ro ert owner� �/ �
<br /> P P Y I'J T�s [__]No I
<br /> Installation �etails;
<br /> Ivh�il type and Lrand M f1V�D was �ntila0ed at Ihis site(Clean Cher.k pWV, Grinder pump, e�c) �/'�o„ > i I
<br /> l'Jher��vas Iha device inslallad (yeneral dnscription aliach rnap�'� ���� , ����--
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<br /> ';`Jas Iherr�;�ny nchci sewer or slorrn drainagc work complelr;tl in r,onjunctwn tivdh the Bb1'D work7 Is so pli�ase descnbe i
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<br /> Installalion Checklist � - "'-'-"' - ,
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<br /> A:c a0 Qo�vn;pnuls and s�lr, �rainayo disconnecled(rom upslream ol If�e�H}ND� � Vns [] No Commenls� �
<br /> Uoc� NW[l posroonmy inccis mimmum slope reywremenl 0(>1'%,'' Ycs � i
<br /> I� (� No Cur�rments
<br /> � rm f3WD�e pulled out for inspection and maintenanr,e afler Inoseniny It�umt�acrew'7 �1'es � J Nc �
<br /> Is BVJ�locked mto thr, proper posit�on and Ihumh screw lighlened? ���r,s [� No 1
<br /> Cncle Ihe yWD r,over ui u over I�i s e re I�a(fic load b��t�y cover(Arive surlar.e) 1 access hatch(hwldiny) i
<br /> '�w�-�'f'C��t� �
<br /> 4Vas prupi;rty on�ner shown c lacahon nt fhe�inslal!er)AI^.';)� • t .
<br /> , � Ycs ,_J No Gomr�enls:
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<br />� Pu�perty Owner's Signalurh-__=�� �,�� , '�, � � , � � � ' i� �
<br /> ��,�:� . -�--�1.�� . � .Dale:_��. i�,
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<br /> Ins!all�r's Si halur„ �/ �'� '
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<br /> L �'`:J_ _� -- C_����1—,�__ -_ ,
<br /> -i �� Dale' / r I
<br /> Hevision� J /
<br /> ' i h9onday, Septembei ]ti min
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