Laserfiche WebLink
R���,i'c�v.�� �€� ��Ev����Q� ��t%ic.� ���.�a� <br />f�lS � A�LFa�lt�i� �H��F�R_9��' <br />installation �ompany N�rt��a an� Con(act Info: �-In c�� �� t' ��� wi u�'�`h <br />Date Bac�nvater Praventien device (B!rdDl eras installed: ���K �� S Date this ferm �,�as completed: y' d�y � S <br />installation Prcperty O��mer Name ar.d Contact Info: vi�(L,�A1��S{�^ <br />�fOp�f�1' ��dd'.�55: ��3 � VC�..��W-C.��Q,! ����. L�i �.:1 -�- � C �'���21i-� �� �- C� ��,��� i <br />Pre•Installation Inspecfion Checklist: <br />u.�l i!ems must be checked'Ves' in order for a B!1�D to be cor,sidereo fori; �stallation <br />Is tn2re a basement cr le�rel of the house thaf is at or near assumed sew�er main elevaGon� � Yes ❑ i�o <br />Are there fxluros in the house loczted b=1o��a the upsiream se�,ver manhcle rim elevaticn7 � Yes � No <br />Is th= side se�.ver currentl� U�'FROTECTED irom sewer baclti�s (do�s nct rave a B�'JD installed)? � Yes ❑ No <br />5ite Inspection Checklist: <br />!U! �tems musf be c. �sckad 'Yes' before inspec!�on is considered compk;e <br />!�'2s side se:ver N i�spected from building !o sewer main? � Yes ❑ No Gondilion: <br />�oes side sewer have at'east 19'o slope from the build�ng to se�,�er maio� 7�] Yes ❑ No Describ2: <br />d=��a all building sew2r drain connec;ions to the side sewer baen identified and located? [�] Yes ❑ No <br />4ave all oroperty storm drainzge connections to the side sewer been identified and located7 �,?.J Yes ❑ No <br />tias pr�pe�;y been evalualed for drainage de5ciencies vritn findings communicated to property o+:�ner? f�j Yes ❑ No <br />Instaliaiion Details: �--� <br />11 nzt :y�= and brand of BV��D �vas installed at this si �(Cican Ch2�k BN Grinder pump, efc ): <br />11'nere �+as he device ins;alled (general descriotion, atlach m3o . �. �k_��n�•.s.e� i n�zr,.c� � <br />l'�'as Ih:rc any other sevrer or storm drainage nrork wmpleted �n r,onj�nction wilh ,he BtiVD +vo�k? Is so p!ezse describ�� _ <br />nJ U <br />Installation Checklist: <br />Ar all deu�nscoufs and sife drainage disconnected irom upstream of the BvdD? r%J Yes ❑ No Comm�n`; <br />Does �GND positioning meets minimum slope requirement of > 1%? �J Yes ❑ No Commenls: <br />Can Blh'D be pulled out for insp2ction and maintenance after loosening thumb screw? � Yes ❑ No <br />Is BbND locketl into the proper position and :humb screw tightened? -�f�-Yes-�-idc�—� <br />Cirde ths BIND covec irrigation cover pandscape are traffic load bearing cover (dnve surfac\e access hatch (building) <br />!Nas property ov✓ner shown tha !ocation of the installed 81��D? � Yes o Comments: <br />Property Owner's 5ignature: Date: <br />Installer's Signafure: , Date: `� ".�1Y -�r <br />c___-r"" <br />i <br />Revision: 2 1 Monday, September 15, 2014 <br />