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2013 LARGE STORM RESPONSE PAPER FORM CIiECKLIST <br /> oare a Nsvecoo�: m�eaea ey: �> <br /> Address: �o !X�/l [�! ServiceReQuestNumber: � 1 c�..-3 c5���t <br /> ResidenC � J�=� Z. rK �� Owr�er? �YES ❑NO <br /> / <br /> � �n�: `(aS• .583� ���S Email: <br /> GanaralBufl�ng DMdls: <br /> �s Ihis puiding witliin tl�e cpnbined sewer area? �YES QNO a Oces tlie bu�ding have a basement? �/ YES ❑NO <br /> Dces Me building hare a bad�wakr valve(BVVV)? ❑Y��'�°/❑NO�� (If yes)Was BNN installed Nragh City program ❑YES ❑NO � 1 <br /> Does tlie huil�ng haue a sunp pump? �YES �►.NO Does Ne buil�ng haue a grinAer pump? ❑YES [�t�l � <br /> Slorm Ev�f ONaNs: / <br /> W1�er¢dd�rakr entering buil�ng oome fran? ❑SURFACE FLOW 0 GRWNDWATER I�SEWER&4CKUP-FIXTURES ❑UNKNOWN <br /> io�: Q',�� ceo�es CAh� o� r.,w��,��� u� nNo <,�o...r� <br /> � —/ <br /> I Where did wa�er go within Ihe bui�ing7 �y'BASEMENT PERIMETER SEMENT NEAR FIXTURES �OTHER <br /> Aµ,c��y <br /> I Oe�ails: SOAIc[ 4 ��2.p�1" fl�A Kcna,,e� c.�-�oa <br /> i <br /> i site oosanasa�s: <br /> i <br /> o�s�us��y�aa�ng�s��a: a oc..n�,�s �N ,�sr S�At ��tc�o ��� veRo - <br /> I <br /> ' Building ekvaGon reladve M sewer and surrounding area issues iroted: <br /> i <br /> Sife Wmp issues iroted: <br /> � <br /> f Hialoriall�ormationl0therintormatfon: <br /> ; Revious'Iboding'issue Senice Requesls al address� <br /> � Previous'Aooding'issues noted by haneowner. Aro.v�. s'�c e d Gva' , � <br /> ReceM slamw�r!sewer pojecis campleted in area: Proposed sPo�mwater I sewer projects in area: <br /> PropeAy owner Intereste4 in beginning City Backwater VaNe Program at address:�YES ❑NO DetaAs: <br /> Notes' <br /> ` Revision:3 TRW 1 Thursday,5@ptember O5,2013 <br />