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� <br />B�f:�l�'A�EF� PR��O�(VTION ��illC� FlNAL. <br />iP��iA�L�4i.E�N CFEECF��.f�� <br />Insfallafion Company Name and Contact In(e: M��-� i��� �� �'� �� y �-/ '� 1-]�p - b' 3� c <br />Dafe Backte��er Prevention dei�ice (BI�l�D) r:as installed: `� '� �( -( J_ Dale this �orm �vas completed �� -��{ -rI� <br />inslallation Properly Ovrner Name and Contact Inro: _�C�u_ (luo�)"�- <br />Property Address: _ � �"� � � V � r�.,•„ ,� � <br />Pre•Installation Inspection Cheeklist: <br />Ail items must be checked'Yes'in order lor a Bl4�D to be consideied (o� irslallaron <br />Is there a basement cr level o( Ihe hcuse that �s at or near assumed sewer main ele��;tion? [XJ Yes ❑ �'o <br />Are Ihero fixtures in the house tocated below the upstream see:er manhole rim ele��alion? ib'] Yes ❑ No <br />Is tne side setver currenliy U��PROTECTED from see,er backups (does nol have a BVi'D ir,stall2d)? [� Yes ❑ No <br />Site fnspection Checklist: <br />All items must be checked 'Yes'be!�r� inspection is considered complete n <br />14'as side sevrer N inspected from building to sev;er main7 (� Yes ❑ No Condilion: I' U� (y-�� ___ <br />Does side sev�er have at Ieast 1%slope from the building to se�ver main9 � 1'es ❑ No Describe: <br />Have all bulldm9 se�eer drain cennections to the side sev;er been idenfified anc' iocated r�k] Yes ❑ No <br />Have all property storm drainage connections to tne side sewer 6een ident ried and loca;ed? � Yes ❑ �'o <br />Has oroperty been evaluafed for drainage deficiencies rrifh findings comm,micaled lo property o�vnen � Yes ❑ No <br />Installatian Details: <br />Vdhat fype and brand of DN.�D tvas ins(alled at this site (Clean Ch�ck BWV, Gr��er pump, e�c.) C�P e.,,� c�.� cl-. <br />�4�here was ihe device inslailed (general descnption, atiach map)? . S� ou►'+ y� �� - ��F („�,. �,�_ <br />'ci'as there any other sewer or slorm drainage vrork completed in conjunction tvith lhe E14'D �tivrk? Is so ptease describe: <br />- r''/l� - <br />Installation Checi;lisf: v W �, �,d�L <br />l�re all dovmspouls and site drainage disconnected irom upslrean of lhe �1ND7 ❑ Yes �] No Comments: ��o ��'��-�- u^�- <br />L�+nnl[NL <br />Ooes 814�D posilioning meets minim�m siope requirement of >1 `/o? [� Yes ❑ tvo Comments: <br />Can BL4'D be pulleA out tor inspection and main(enance aiter loosening ihumb scre�ti�? Q] Yes ❑ �o <br />Is EIWD locked inlo the proper osiGon and Ihumb screei tightened? �� Yes ❑ A�o <br />Circle Ihe 641�D co��e rr' lion cover dantlscape area) I traffic load bearing cover (drive suriace) I access hafch (buildina) <br />lMas property o�vner shown the location of llie inslalled BUJD? [J Yes ❑ No Commerls: <br />Property Oe��ner's Signature: Da;e: <br />Installer'sSignature: °`,%�Gf � }2--f'— Date� �-1 ����� j 5 <br />Rcvision: 7_ <br />Monday, Sepietnber 15, 2014 <br />