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I <br /> � <br /> B�ICKWQ.Ti ER PRl:VENTION DEVICE FINAL <br /> �NS7'A,LLATIniV CHECKLIST ; <br /> � <br /> Installation Company Name and Contact Info: M ��n 1���,'^'''.n y �!� 1 7�U—6'3�c ' <br /> I <br /> �ate Bac6�vater Prevention tlevice(BIND)was installed: �('I O-I � Date this(omi�vas compleled: `!-!c�-!S ! <br /> Instaliation Property Ovmer Name and Contact Info: Tor C�'�e � �'�� � Fr �� 7y2 �7 ; <br /> Property Address: � � ( � Lvr,�i�., � �� � <br /> Pre-Installation Inspection Checklist: � <br /> All items must be checked'Yes'in order for a 8WD to be considered for insfallafion i <br /> Is there a basement o;level of fhe house that is at or near assumed sewer main elevation?[K]1'es ❑ No <br /> hre lhere f�ctures in the house located belova ihe upslream sewer manhole rim elevation?0 Yes ❑ No � <br /> Is the side sev,�er currenlly UNPROTECTED from ser�er backups(does not have a BWD inslalled)? [s�Yes ❑No <br /> Site Inspection Checklist: i <br /> fiU items must be che�Yed`Yes'6efore inspectior is considered complete ; <br /> Was side sewer N inspecied from building to sewer main? �Yes ❑ No Condition: 5����P� ! <br /> Does side sewer have at least 1%slope from the building to sev�er main? �Yes ❑No Describe: <br /> Have all builtling sewer drain connections to the side setiver been identified and localed? �Yes ❑ No <br /> H2ve all property slorm drainage connections to the side sewer been identiGed and located? �Yes ❑No <br /> Has property been evaluatetl(or drainage deficiencies with findings communicated to properly o�vner7 �Yes ❑ No ` <br /> Installation Details: ck�,� k va� <br /> What type and brand of BVt�D�vas insialled at this sile(Clean Check BWV, Grinder pump, etc.): i=���L oz,�r Z <br /> N'here was the device installed(general description,attach map)? ��v�� c�/Z-,`h �h Sc c� �w-� � <br /> `�' � (v� �.� i vt. L..G�(/ G.Cir_ ��: Jc.l..c w•.2,G-� �/o.K' -- � <br /> Was lhere any other se�ver or storm drainage work completetl in conjuncfion with thu BWD work? Is so please describe:_ � <br /> Installation Checklist: 2�� •, <br /> kre all downspouts and site drainage disconnected from upstraam of lhe BWU? ,�Yes ❑ No Comments: � <br /> Uoes 81ND positioning meels minimum slope requirement of>1%? ,�Yes ❑ No Comments: � <br /> i <br /> Can BWD be pulletl out for inspeclion and maintenance after loosening thumh screv✓� ❑Yes ❑ No } <br /> Is BIND locked into the proper position and thumb scre�v tighfened? ❑Yes ❑No ; <br /> Circle the BWD cover: irrigalion cover(landscape area)1 traffic load bearing cover(drive sudace)1 access hatch (building) ��� � <br /> bVas property owner shown ihe location of the installed BWD? �Yes ❑ No Conments: � <br /> i <br /> i <br /> Property Ovaners Signalure: Date: � <br /> Installers Signature: � � Date: � '(�—f � ' <br /> Revision: 2 1 Nlonday,September 25, 2014 <br /> i <br />