2225 WALNUT ST 2016-01-01 MF Import

� BACKWATER PREVENTION DEVICE FINAL INSTALLATION CHECKLIST Installalion Company Name and Conlact In(o: Oate back�vater device (BIND) was installed:�� Installalion Property Owner Name and Contact Inio: Praperty Address: � 1� Date this form was completed: �—i �—/ S Pre•Installation Inspection Checklist: A!I items must Ge checked'Yes' in order lor a BWD fo be considered lor insfallafion Is there a basement or level of lhe house thal is al or near assumed se:ver main elevalion7 �j Yes ❑ No Are there fxlures in Ihe house located belmv Ihe upstream sesver manhole rim elevation? �Yes ❑ No Is Ihe side sewer cu« ently UNPROTECTED Irom se�ver backups (dees nol have a BIND inslalled)7 � Yes ❑ No Site Inspection Checklisl: AII items must be checked'Yes' belore inspection is considered complete Was side se�:�er TV inspecled from buildina ;o sewer main? � Yes ❑ N,�o Cond�fion: Does side sewer have at least 1%slope from lhe building to se�ver main? �� Yea �^lo Describe Have all buiiding server drain cennections lo the side se�:�er been idenlifed and located? �Yes ❑ No Have all property storm drainage conneclions to lhe side sewer been idenlifed and Iccaled? �'Yes ❑ No Has property been evalualed tor drainage deficiencies wilh findings communicated lo properly o�vner7 � Yes ❑ No Installation Oetails: What type antl brand o` BWD was inslalled al this sile (Clean Check B14�V, Grinder pump, etc.) � Where was the device inslalled (general description, attach map)? � Was lhere any other ser:ei or slorm drainage e+ork compleled in conjunchon �vith Ihe �BWD work7 Is so please describe: Installation Checklist: Are all downspouls and site drainage disconnecled from upstream uf Ihe BWD7 ,V I Yes ❑ No Commenls: Does BNN positioning meet minimum slope requirement of >1%7 �Yes �j No Comments. Can BNN be pulled out for inspeclion and mainlenance a8er loosening Ihumb screw7�Yes ❑ No Is 01^N locked into Ihe proper position and thumb screw Ugiilened7 �Yes ❑ No Circle the BV�N cover irrigation cover (landscape area) I IraKc load bearng cover (drive surlace) ! access hatch (budding) INas homeowner shown lhe localion of lhe installed NBVJD7 �es ❑ No Commenls. i Properly0vmer's Signat Date: S -/�- � � Installer's Signature: Dale: _ � )T�y — /� ' Revision; 2 1 Thursday, October OZ, 2014