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B�4C64W�T�� �t��lJ�RliIQN DE1lIGE FIf�AL <br />�I�STA�LRTlQfV CHECKP_ISi <br />Instai�ation Company Name and Gontact Info, ���G��C' I��ti.wll� �s <br />Oate 52chv;afer PrEvention dQ�7ce (BW�) vras installed: y/9/is''' �ate this iotm was completed: �// �� <br />Installation Propery Owner Name 8nd Confact Info: /3c"�s'i' G/ C</� <br />PraperlyAtldnss: � Gf✓L3Y <br />Pre•Instaliation Inspectfon Che�klist- <br />At� r,cros +rust he checked 1'es' in order far a BVJO �o be considered iorins(aliaGon <br />1=lhere a 6asement cr levei ot ihe house tnat is at or near assumad sewer mai�t efevetion9 �j Yes ❑ No <br />Ar� there fixtures in tho house located 6elow the upslream sev+er manhole tim elevation? � Y�s ❑ No <br />?� Hie �i�e se�tiror currertly l7P:PROTECTED trvm setver backups (does not have a 8V�'D instalied)? Ej Yes ❑ No <br />Sile inspeetion Gheckllst: <br />till,feii�s must be cl�ecked 'Yes' beJore inspection is cvnsidered camplete <br />Vti+as side sewer N inspecied from buildin� lo sewer main7 7U Yes ❑ No Gond�tion: <br />Does side sewer have at least t� slope �rom ihe buiiding to sewer main7 � Yes ❑ No Describe: <br />Ha�e aii 6uilding sekrer drain conneclions lo the slde sewer been iden�fied and Ixyled9 7(,� Yes ❑ No <br />Have all property storm drainage connections to the side sevr�r been itlenG6od and located7 pl�'es p No <br />Has properiy beon evaluated for drainage deficiencles �vlm Fmdings wmmunicated to properiy ownerr �Yes ❑ tJo <br />Installafion Details: <br />lh'hat type and brand of BVJ� was installed af Ihis s n Check BVJV, - irtdef pump, eta): �i i' S <br />1't'hero was Uio devlce installed (genb�a) descriplion, nttach map)? 1., d�sc.•.��' <br />V�'��s there any other sevrer or slorm dtainago tivotk Campletetl in conjunclion ��rilh the BWD �vork? Is so piease describe: _ <br />Installation Checklist: <br />Are all downspouts and sile tlrainaya disc�nnectetl (rom apstream of ihe BWD1,{�] Yes ❑ No Cnmmenis: <br />Does B1�JD positioniny meets minimum slopo requirement ot>t%7 ��] Yes ❑ No Comments: <br />Can BVJD be pulled out for inspection and maintenance a(ter loosening ihumb scre��7 [�Yes ❑ No <br />Is 81h�D fock�d inlv ihe �ra eypnsilion-a�?t�-4 run '' +tighlened? �] Yes 0 No <br />Circie Ihe BWD co� .. irrigation cover land ��e�taa�-�{�c Inad beanng eover (drive surface) / aecess hatch (bwlding) <br />Was properiy o��rner shown the location of ihe inslalled BWD? � Yes ❑ Ab Comments: <br />Property Ovrner's Sign � _'� v r Da�2: � f�c7 �� <br />Installers Signat . Oaie; W,�/ris"� <br />kevision; 2 <br />Monday, September 15, 20?4 <br />