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<br />BACKWATEfl PRLVI_NTION D[=VIC1.= I IN!!L
<br />INSTALLATION �'HLCKLISI-
<br />inslallafiunCuinpanyN�mcanJCu�i!,u:ihd� Io,vaa2Co,v5��?ve7�a���d�,�s
<br />Datr, Rrckwater Prevenlinn devir.�� (H�AIf )) w;c, in�,i,,!ir� i/ �� 9� � S i i: �:� i l r. 6,m � w. �
<br />Inslall2licn Property Owner A'ame and ('�>nlrr.l Inlu C'�i"rh�t C`> �L��
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<br />Properiy�ddress ��(_�� _ t~��-/�'L-- �,r�
<br />Pre•Insfailation Inspe�tion Cliecklist:
<br />AJl rlems must be chsr.ked 'Ves' in ordei !oi ,� i; wn r�� r,�, ,:,,,,�:;, t� �,,,�d i;;, ,,,tii, dl; �Ir, rn
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<br />Is Il�ere a basernent or Ir.vel o( Ihe house Ihal is .d or ne;u ;r;sinncd sec�cr m;iin c;i:v;tlion'� ��e:, � j tJu
<br />hre Ihere lix.lures in Ine house located hclo�v �he ups(rermi serir.i manLul�� mn r.lcv,tlion7 ��'cr; � � Nn
<br />Is the side sev�er cur,enlly UNPROT�CI I`D (rom sc�v::i b;ickup:; (�;oc,: �in! ha•+i� ;� 1,4VU in,l:dlcd)'� ��jYe:,
<br />Sife Inspection Checklist:
<br />;rl �te,ms rr�ust he r.hecked'Yes'belore rnspeclro�r i;; cunsdned r:umpletu
<br />4'vas side se�ver N inspected from buildiny to setiver m�iin? �.�{" fcs �� ra„ Cuudd�u �
<br />Dues side se�.ver have a! Ieasl 1% 51utx.� (mm flir, buildutg (u sr.��n;r ns�in'� ��{"Ycs � j Nu f)i�siaihc
<br />� Nc�
<br />Havr, all building;ewerdra;n conner,tion, lo Ine sidr. sr.r;c� br.�:n nl��nblicd;iud lardr.d? �%j Y�a; �� Nu
<br />ha';e all properlyslormdrainagr. connecticns lo lhr. si;le se�ver ber.n idr.nlihal;m�l lur.;dc�l7 �'� Yu�; � � Ni�
<br />Has propt�rty bcen evalualr,tf (n; drainriyr. dr.6ricnr.ir.:. �.v�lh linduiq�: �.��inniuinr.:drd h� �ru, rity uvrn��i�� �'I 'r�"• � I Nu
<br />fnstallation Details:
<br />l�vhat type and hrand ol 131�VU �vas inslalled a( Ihi� sile {Ur.;m Chcck 13WV, Grindci punip. r.ir. )(�i r'i�f� (�(i r.'G�
<br />NRierr. �vas Ihe device inslalled (yeneral descripfinn. all;ir.h m;iPJ�� ��� �� 5 i Ce�
<br />�Ves Ihcre any oUter sewcr or ti�onn drainayc �vork comph:tr.d in r,�mjunr,liun �:�ilh Ihr. Rl4'f ) wc�rk� L; su plc,ise dr.scribr
<br />Inslallation ChecklisL'
<br />Are,�il down:;pouls and sile drainagc disconneclr.d hom up:;lic,un ol Ihr. 13V�'l l'�
<br />Do:�s fiVVU posi�innini� mecls minirnum slopc rr.quircuicnl uf �1'%,"� � �� Yrs �
<br />I`� �","; I I N�, c���������,��e;
<br />� Nu f:uiunicnl�,
<br />G�n 13th9) hr pidlc�l uul lor mspr.r.liun �rnd inninlcn:incc ,iNri lun�.i�mnu liiiunli:;r.icw�' �`����"• � I N��
<br />IS fiNJl) I;�c�cil iido Ihc ptu�ier pnsfiun and Ihwnb �,i:iuv; lu�litcncd7 ji� Y,,., � � W��
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<br />Cirdc Uu• Il4VI) cuv�i>urirj:�lion r.nvr.r Uandsr.apc ��rr.�i}/ li�dlir.land hr.�mnq cuviv j�6n��� :,iul.in•) /.0 � �., Ir.d� h(I�inLhwl)
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<br />V;'��5 �nn�icily uv.�ucr nlir.r:n Ilir. ocafiun Ci u,�: ����.i,�ii���i ii���n•� ��,i j � Nu Crnnm��nl :
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<br />PfOp�a��� 1 h4iU�i�':.`�r�li.ili ir. �� � U,il�� ��/ `- 7�%.5�
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