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�5/U1/2�15 ]3:23 <br />�' <br />� <br />42545^5176 <br />STB <br />BACKWATER PREVENTIO'Y DEVICE FINAI. <br />INSTALLATION CHEC!(LIST <br />Pn�E oaiaa <br />inslallation Company Name and Contad In(o• �� � � y. ��- <br />Dale Bachwn!er I'revention device (BV�'D) ��es inslal'ed���_ �� Uate :his f�rm was completed � <br />Ins!alla",ion Property Owner Name and Conlacl In1o: �`i� V�l� � �_t= � P�_ jrJ 1,, �2c LC �_ <br />Property Address: <br />ni� fI�L <br />Prc-Installelion Inapection Chttklist: <br />AH ifems must be chscked 'Yes' in order lar A AV✓D lo Ae considered (or InHalla!ion <br />Is Ihere n ba,emenl oi level uf Ilie house Ihat ls a1 or near assumed se�ver main elevaLon? � Ye5 �] No <br />Are ;here fr�lures in the house iocafed 6elow the upstream sewer manhoie rm elevafion?� Yes ❑ A'o <br />�s ihe mde see�ar curten!!y UNPROTEC i cD Irom sewer backups (does not have a 8WD �nstalled)7�,J �es ❑ Vo <br />Site Inspectian Checklist: <br />Afl itens mus! be checked 'Yes' befam,nspecticn is considered wmplete /1� � <br />Wa5 side scw;r TV inspected lrom building to sev�ei ma�n? �YeS ❑ NO Gondition:'—��JlJ� �C��nf' Q�% ��� <br />Dces side sewer have at leasl 1`b slope irom Ihe 6uildng fo sewer main? � Yes ❑ No Descnbe. <br />Have aii bwlding sewer drain connections to ihe side serrer heen id?ntified and Ic-ated7 [�Y,�e.-/s ❑ No <br />Have all prope ,ry slorm drainage conneclians lo the side sewer teen idenlilied and localed7 L�,Yes ❑ Nn <br />Has property been evalualetl fur drainage deCciencies vnth fndinos communicaled In propeM/ owner7 'j� Yes ❑ No <br />Inetallation Datal, :; <br />Wha! type and b!and ol �WD was Installed al lhis sile (Clean Check /B�V,.N, Grinder pump, elc�/��OC� ��I t� <br />Whem was Itf�d�cvice inetolletl (gpncrel desciiplion, al'�@;:6 map)7 '1 �A�/; C� ��(iY��JC`��" <br />kl� "�P /1` � n I��ti � r l a�,.r` <br />Wa 1��cre � y ofiei aec�er or Slorm f3ln�ge i <br />SZ�� �a' <br />InYtallallon Lhetklist: <br />in ton�unclion with the BIM1�t,� wpM? Is so please <br />Are all dovm;pouts antl sile dramage disconnecled Irom upslream of the BINU� �Yes ❑ No Comments ____ _ <br />Does B1Nu positionmg meels minimum slope requiremenl of >1°�? j� Yes ❑ No ^ommonls. <br />Can BWD 6C puPed OUIlor inspeCfiOn and maintr.n�nce afler loosening Ihumb strav/� � Yoc ❑ No <br />IS BWD lor.ked into Ihe proper posilioo and Ihmnb scmvr lighlened7 [� Yes ❑ No <br />Circle tha BWD cover. irdgation cover (landscrne area) l lraffc load bodriuy wver (dnve smlace) J aCCCss halch (Oullding) <br />lVas property owner shown Ihe !ocalion of fhe Installed BWD? �� Yes ❑ No Gcmmenls <br />`.,-i :_ r/ <br />Property O.vner's Sign ir L�`�—� Date: � /f <br />� -� � <br />inslaller's Signa!urc: , Dale: ��� `/� <br />Rcvislon: x \ 1 Friday, Septemher 12; 2014 - <br />