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�e��C���t�.'�'�� ������`�'9�� (���'@�f�' �9�4��. <br />- ����TT�.N�� ��'BQ�� ������ 5��' <br />._,__.�._-�,----=_��Q__��= a--..�z-,�._ <br />instaiiation Company R�2me and Contact Info: �iD�n �(,�,,� „� <br />L'a;e Backv;aterPrevention devic� � � 1 °Z� ��U �3��;_ <br />-(B�4�D) v,as irsfaifed: 10- i���_ Dal? ihis fc,m v;as completetl: + �- r y-,� <br />Insiallation Property O�vner t�'ame and Coniacf Info: �-� !, U� fl ��o c���� <br />Frcoerty Addrnss: o� �� 3 U V r r L�, ,-� ---�.—"' <br />Ci�1.�L <br />?r�•Installatiun Inspection Checl<list: � ' <br />:;�i ;;ems must Gz checked 'Yes' in order ior a 8WD fo be considered for inslallaiion <br />I; th:re a hasement or!evel oi the house thai is at ornear assume,: se�:�er main elevationl �j Yes ❑ fdo <br />Are fherc nxtures in the house loceied belo�v the upstrean seuer manhole rim elevation7 (�Yes ❑ ho <br />Is the side se��;2r currentiy UNPFOTECTED irom sewer backups (does no; have a 64UD insfalledj? [� y� <br />Site Inspecaon �hecL•lisy; <br />❑ A'o <br />; ii dems �, us� be ch,ecked 'Yes' 6eiore ir,soection Is considered com,plere <br />!�vas side s a;:�er TV inspecfe� irom huilding to sewer main? �Yes ❑(�b Condition: �/ � � <br />Dces sida se�,ter ha��e at least 1°o slope from the buildir�g io sev;er main? OYes ❑,do Describe: �� <br />I;zve all building se�verd; ain conneciicns to ;'r,e side se�.aer been idenu,5ed and loceted? � Yes [� ho <br />Have zll propery stcrm drairage comections to ihe s;de seeler heen idenu�ied antl locafzdl � es ❑ No <br />Has propory heen evaluaied for drainage denciencies �vrh findings commuNcated to property oumer? � Yes (] t�!o <br />In�taliailon Ueiails: <br />41'hai iype and brand of BbUD �ti�as installed at ihis site (Clean Check 86llV, Grincier pump, etc.): � �<<�� c�.�lt <br />!"'here �vss the de�rice (nsfalled (general :iescripflon, aliach map)? S:i, �- / <br />_ �' 1. �� ___L..__;.���. _..,.�.... __.,_,.. <br />b'.as Uiere any oth2r sat;�eror stom drainagf �vork comploied in eonjunciion vrith the BIND e,ork? Is so please doscribe: � <br />-- --___ — <br />In,iallation Checldlst: -- - ------ <br />;1re all dot�✓,�spouts and siie draina�e disconnecied from upsiream of lhe [iIMD? � Yes [J No Commenis: <br />L'oes 814�� positioning mezts minimum s!ope requirement of >9°l0? (� Yes ❑ No Commenis: <br />Can BWD be pulled out for insFeciion and m.�inienance afler loosening thumh screvd? �] Yes �J f�o <br />Is BWD lociced into ths proper positlnn and ihum6 screv, tightened7 (�] Yes ❑ No <br />Circle tn� 6WD eover � o3tion coye Qandscape area) I tra�c losd bearing cover (drive sur(aceJ I access hatch (buiiding) <br />Was propery ov�ner shown lhe location of ihEi installed BWD? � y� � No Commenls: _ <br />Propsrty Ovmer's Sicnaiure: Date: <br />Insta!ler's 5ignature: �--C�� �--�,�_ Date; ! �-�v - � r <br />Revlsion: 2 1 Nionday, September 15, 2014 <br />