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� <br />� <br />BACKWATER PREVENTION DEVICE FINAL <br />INSTALLAT�ON CHE�KLIST <br />Installation Ccmpany Name and C�nfact Info: <br />Date Back�r�ater Prevention device (BIND) v�as insta <br />Installation Property O�;�ner Narrle and Contact Inio: <br />PropErfy Address: <br />� <br />Date ihis (crm was completed: <br />Pre•Installation Inspection Checklf5l: <br />All items musf be checked'Yes' in orderfora BWD to be considered forinstallation <br />Is there a basement or level of Ihe house fhat is at or near assumed se�,ver main elevation� Yes ❑ Vo <br />Are Ihere fixtures in the house located below the upstream se�r�er rnanhole rim elevalior? Yes ❑ No <br />Is the side sewer arrently UNPROTECTED irom se�•;er 5ackups (does rol have a B�+VD installedl? [� Yes ! I No <br />Site Inspection Checklist: <br />lall items must be checked'Yes' before inspecfion is considered complete <br />N�as side sewer N inspecled from 6uilding to sewer main? � Yes ❑ No Conditicn. <br />Does side sevaer have at least 1°�o slope from the building lo sewer main? 'j� Yes ❑ No Describe: <br />Have atl builtlinn se�ver drain conneclions to the side sewer heen identdied and located7 �,Yes ❑ No <br />Ha�-? all property storm drair�age conneclions to the side sewer been idenlified and located7 '�] Yes ❑ No <br />Has properiy been evaluated for dramage de(iciencies wi(h ings communicated to property o�rmer? � Yes ❑ No <br />Installation Details: <br />Whal lype and brand of 8WD eras insfalled at this site le n Chec BWV, Grinder pump, etc.): <br />'Jt�here was the device installed (general description, atiach map)? ��� __ <br />c <br />Was Ihere any olher sev�er or sform drainaye work compleled in conjuncfie� .ith the BWD vrork? Is so please tlescrihe: _ <br />Installation Checklist: <br />Are all do�vnspouls and site drainage disconnected from upsiream of the BWD? Yes ❑ No Comments: _ <br />Dces BWD positioning meets minimum slope requirement o(>t�o? �Yes Na Cainmenls: __ ____ <br />Can BN'D be pulletl out for inspection and maintenance atter Icosening thur�b screw? �Yes ❑ No <br />Is BWC !ocked into the proper position and thumb scre�v tigh�ened? �Yes ❑ No <br />Cude Ihe BWD cover: irrigation cover (landscape area)1 traffc load beanng cover (drive surface) I access halch (huildin;; <br />'1�1as properly o�vner shoa+n lhe localion cf lhe installed BWD7 Q�Yes ❑ No Comments <br />Prope�ty O:vner's <br />Inst211er's Signatu <br />Revision� . <br />'1'�'1- �ls-:-' ��� - <br />�-��� ''"��_ <br />�tember 12, 201� <br />