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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> Err <br /> Daleofins�ctiore ����`1 -/ 3 InspecledBy:�At,c p" � 7 �r� ��{.f«tyr�-� <br /> ' Ci01 ��J ! (o <br /> Address: �i � ,�-,� �� Service Requesl Number. . <br /> Resident `�. � L. �.t .i'�-�� Ownor9 LyYES ❑NO <br /> Phone Num6er. �{�. � � 3u 3 - 8o sv Email�, <br /> G¢neral Building Details: <br /> Is this bulding wilhin Ihe combined sewer area7 YES ❑NO Dces Ihe building have a basement? YES ❑NO <br /> Dces he building have a backwater valve(BWV)1 �YES [�NO (11 yes)Was BWV installed through City program �YES NO <br /> �o�s n,c� r1�,�R s� <br /> Oces Ihe building have a swnp pump? �ES Q NO Does Ihe buildmg have a gmder pump? ❑YES NO <br /> `l�'S aAcl� 9Mto <br /> Storm Event Details: <br /> Where did waler enlering building come hom? I]SURFACE FLOW ❑GROUNOWATER SEVIER BACKUP•FIXTURES ❑UNKNOWN <br /> Details�. �vf,'(,;� L !ti!`�E L�J�I r�r "tu�lc f � /��tuT R �I (�Ce�' � <br /> Where did walcr go vrilhin Ihe building? �,�'BASEMENT PERIMETER ASEMENT NEAR FIXIURES OTHER <br /> ,i �i <br /> belails: 11i�� �IpAI ',1k j�v phSC�tN( -7, riAiEi"t;�i l-1�5 �tx'1f;te.� rfP-f�✓�p ✓�� <br /> �I � T, srow.� s vc�c•� n�tfiy <br /> Site 06servations: <br /> Downspout I site grading issues noted: F»�J N5�'D�'(5 j���Cl1:�u (�,e 2 �(� FSi:�J ti�?i sC�✓t'? <br /> Building eleva�ion mlafivc lo sewer and surrounding area issues noled' <br /> Site pump issues naled: <br /> Historical Intormallon I Other In(ormation: <br /> Previous'Aooding'issue Service Requests al address: <br /> Previous'Oooding'issuesnoledbyhomeowner„]D�O ��ord��, UfSJiooS RCQa�� �i� /Sm��������C, N��!'�� rlq:..in- <br /> Recent stormwa�er/sewer projecls compleled in area: Propose stortnwaler!sewer projecis in area. <br /> Property owner inleresled in beginning City Backwater Valve Program at address, 1'ES ��0 Delails� <br /> Noles: <br /> Revision:3 TRW 1 Monday,September 09,2013 II <br />