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<br /> 'r`- BACKIIUATER PREI/ENTIt�N DC1/IC;L= (=INAI_. '
<br /> �-� INSTALLt4TION CHECI�LIST
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<br /> Insta(i�tiori Cornpany N�me a�ici Cc�nl,�c( li�li�"�1��::;u.���� c':'��i���'�`�`��=�'������i���� �`�.������,��''�� �
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<br /> Date Backwat�r Pi�evention devic�(E3Wf)}wta; ins;l,,ll���i� �/������ I�,���� ii�i., i����r�� vs,�;�<<��r���l��l�:�l ��/���'�� ��
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<br /> Inst�ll�tion Property Owner Nanae and Cai'�t�ir;l Inl��. ��� �-���� 7������t,%i�� _
<br /> Property Address � l�..l�=: �'�4�•v_��;-��G.-�.�t.`'�#�� �.-�Gr�
<br /> Pre-fnstallation Inspection Checklist:
<br /> All ifems must he checked`Yes'u�vrder for��L3WU lo(�c r.r�rzsic�c�r��f Ic�r ins�r�Nr�lk:�n
<br /> Is there a basement ar level of#h� house ti�at is ai ��r nc,3i ,i�,s�i�i��cd��ewcr nr�iia +:Ic�v,'�lita��'� � �`(�Yc:, � � N��
<br /> Are there fixtures�in the house loeat�d beiow ilte ul�strer�t�1����t�wtrr n�r�nlx��l���ii�ii t:Icv�aliG�n"?( �Y�:�� � � Nn
<br /> fs tne side sewer currently UNPROTEC�3-E[J froili s��wt;i�I�ac;kt��p;, (��r�c�:; n��i lir�vc,� E3WO in>i��llcd)'?J���t", � �N�
<br /> Sife Inspection Gheckfist:
<br /> AI!lterns must be checked`Yes'b��fote rr�s�ecti�arl is corist�i�;�r{.a��cviriFalel�,�
<br /> Was side sewer N inspectetl from building to sewer i����iti'? ��Yt�s � ] Nc7 (;c�ncjiiioi�: '.
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<br /> Does side sewer have�t least 1°10 siope from the l�uildinr�lo se�w�:r n�ain7 �Y�;:; � ���: � '
<br /> � I Nc7 !)�.,� i�ln�: _. _�_. �
<br /> Have al!buiiding sewerdrain cflnnections ia tt�e sir�c sc�wc�r l�c�c�n icic:ntilic�l r�ncl Ic���.�l�;�i`? � Ycrs � � N��
<br /> Fiave all properfy storm drainag�conneciinns to ihc,sidr�Scwar been idenlificei<�n�1 Icx;�3ir.+1'? �'`�Yr.�; � � Nn
<br /> Nas property been evaluale�� fordr�i«ayc defiici�;ncir.s wilii fin�iin��s �;��nrn�iiinic,��Ie�l ir���r��peiiy r�wn��i"� � '�Yn�, � � N��
<br /> Installation Details:
<br /> Whaf type and brand of BWD was insfailed at this siie((;lc�in (;heck (3WV, (�rinci��r ���>>iil}, ��1r, ) L��'���'t�-�L�� ;.
<br /> Where was the device installed (general description, af(��ch ma��)'? �, �, ('������.�;r� �;`' ����� __ . �
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<br /> Was there any other sewer or storm drainage work cc�n�plelcld it� �,t���jui�r;iic�r� wifh U�e E3UVf)wark'? !:; �;t, ��ic�,���ciescribe:_ _ �
<br /> Installation C1�ecklist:
<br /> Are all d�wii5�ouls ��nd site drai��age disconr�er.iccl fror�� �i��s(�c;��in c�i llu� l.3Wl)'? (�r;s � j Nc> (;�,n�nie�ii;:
<br /> Doe� f31N� p�siiirtmin,g rrtt;ets mi��irt�urn slo�>e rr:q�iircincn�l�7f=���1"/;,"� �--'�Yes ( � N�.� (;���nlr�uiiL�;
<br /> ��n I3W�J fit� (���Ilc{7 t�ul f��r i�ts(��?�;Lit�rt����r� �r�t�in(cn,�rr<<��;�i((ci ir�tq�,t,t�it�r� �I���i��l� ;cr��w;' ��1'���, � � N�r ,
<br /> Is BWi))ti�'kc�l in1�� II��� �����E�cr po���«w�.-��ncf fhtniii��>�;ri��w Ii��i�l�:rii��J'� �`�Yc�; ( � Nr�
<br /> Circic�lhc {�iWl)c��vc�: i����[ion coytat j�la`ndsc����c r�ir�����)/lr��lfir.I�x�rl hf;arin�� c�>vE�r (�liivt� :;ii�[�u:��)/;��r.��:�,�,�; fi,�icii (I,uil�fiii�i)
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<br /> Was ���nf�E��ly��wncr sli��wn (!u;I�ic��(it�n of il�it� in�;I�iNc�i !iW[?`� � -��Y���; � � Nn t;un�n���r�1��,
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