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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> Date of inspec6on: J Q � > Inspecled By:����(Gn /�/00 [ .�� <br /> Address: � ���t LG� AL �!V� Service Request Number: UD���G ZO <br /> ResidentS (� e� (�0 �AS Owne�? �YES �NO <br /> Phone Numher. ��� 3 � 1 ��I < Email:_ <br /> General8uilding Details: <br /> Is this building within lhe combined sewer area7 ✓LJ YES �NO Does the huilding have a basement? YES ❑NO <br /> Does ihe building have a backwater valve(BlM�7 �re5 ❑N0 (I(yes)Was BWV installed Ihrough Cily program j�YES ❑NO <br /> Does fhe huildinq have a sump pump? ❑YES �rv0 Dxs Ihe building have a grinder pump? ❑YES �1�f0 <br /> Sfortn Event Details: <br /> Where did walerenlenng building come irom7 �SURFACE FLOW �GROUND�VAT[R SEWER BACKUP•FIXTURES ❑UNKNOWN <br /> Details, C�M e- f�U Gt � � � i �"'GL �-�^'� �� <br /> � <br /> Where did waler go within Ihe building? U ttASEMENT PERIMETER �ASEMENT NEAR FIXTURES ❑OTIIER <br /> Delails:���v� I h/fG/o Il �S��D �7— /3 Ci'�Ih °n� fY-/-�A. <br /> i i <br /> 5ite Observations <br /> DownspouV sile grading issues noled: I�I�S S�/)11 11�G-T P�� �r��vS/I �S(F..�+ � <br /> Buiiding elevation relative lo sewet and surrounding arca issues noled: �41�n�-� � S ��^'�T (�/�f S '��`��^� � <br /> Site pump issues noled: i <br /> Historical Inlortnation 1 Olher Informalion: � <br /> Previous`(loodinc�'issue Service Requests al address:��_(,li71 � � �G �-(J �0 � �-f � <br /> Wevious'(looding'issues noted by homea�mer. _ I <br /> � <br /> Recenl stormwaler I sewer projecls compleled in area: Proposed stormwaler I sewer projecis in area i <br /> i <br /> Property owner inlerc5led in beginning City Backwater Valvc Program al address 8YE5 �NO Details; � <br /> Noles: �A S�.9Fi1 Q� (�wV �'I n� 11 H�" In��j (Jrl.Grvia� �l�i�Er(6�L�i� � ��(.�f S <br /> fn L/Y✓r6 ��G�1'1 W�C/4J �l (L �l.L�'tJ[l �� (`A /�v� ln./Dllc SI� U!' _ I <br /> I <br /> �� lr✓'�/' . � <br /> Revision:3 TRW 1 Thursday, September O5, 2013 i <br /> i i <br />