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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> (477 <br /> Date of inspection: ( V(*--01 Inspected By: l36/i,fi bOD/ice <br /> Address: .?c----( S I,//i'✓Lo( 6 4f /+n-01T) Service Request Number: <br /> Resident: /✓\4 ((Pr, Owner? ❑YES ❑NO <br /> Phone Number: Email: <br /> General Building Details: <br /> Is this building within the combined sewer area? 121C❑NO Does the building have a basement? ❑YES ,®NO <br /> Does the building have a backwater valve(BWV)? ❑YES [ NO (If yes)Was BWV installed thr City program ❑YES 0 NO <br /> Does the building have a su pump? 0 YES 10 Does the building have a grinder pump? ❑YES E"NO <br /> Storm Event Details: <br /> Where did water entering building/come from? 0 SURFACE FLOW 0 GROUNDWATER ElI SEWER BACKUP-FIXTURES UNKNOWN <br /> Details: \T YY7(!� c/ C�c I S 24,..e e._ , ,_,/ <br /> Where did water go within the building? ❑BASEMENT PERIMETER 0 BASEMENT NEAR FIXTURES 12 u i HER <br /> Details: 7:.-caAne-Z S pli.e g.- <br /> Site Observations: /� <br /> Downspout/site grading issues noted: �/6 4 L-yl S c'r)u" c 5 G f-d g —e.„--- <br /> Building elevation relative to sewer and surrounding area issues noted: 134.0? v'4 E al t Z Lvp,t v`,11, G9ay <br /> Site pump issues noted: <br /> Historical Information I Other Information: <br /> Previous"flooding"issue Service Requests at address: ((a ( de41L f—D a t'14,u 9L- g P/�-s26- me,€,A <br /> Previous"flooding"issues noted by homeowner: <br /> Recent stormwater/sewer projects completed in area: Proposed stormwater/sewer projects in area: <br /> Property owner interested in beginning City Backwater Valve Program at address:❑YES ❑NO Details: <br /> Notes:7 p�,,r s +'o Soai 5 Gd( a- v 1 7 . F l fat& S (I/'L/" <br /> I , ct.„,sei- s...e/v—e--,r- )(111(4,tAl Aipi,e,, les.(h ci,e, C rt7A4 t ?Ca,a-- FlifActi:1 <br /> t S at J iffic_6 '- <br /> Revision:3 TRW 1 Thursday,September 05, 2013 <br />