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- __ _-- �-- -- -- - - - -- --- <br /> -- - - --- _ _ _ . _ . <br /> 2013 LARGE STORM RESPONSE PAPER FORM CHEGKLIST <br /> c�-r,.���1�,,�•-� .�u-"-�- �`��"j � a�/�.�U-h <br /> , /� q /� �/ � <br /> Dale o(inspec�on:�J � l l Inspecled By:_v n.1L.�� /7 D�� � <br /> Address: �J�i�� I 1 D� t • �t Service Requesl Number: _ <br /> Residenl: ���1�1A Owner7 ❑YES �NO <br /> Phone Number: � Email: <br /> I <br /> General Building Delails: <br /> Is Ihis building within Ihe combined sewer area7 �YES ❑NO Does Ihe building have a basement? �YES ❑NO j <br /> Does Ihe building have a backwater valve(BNM? ❑YES (�]NO (If yes)VJas BWV inslalled Nrough City program []YES�NO <br /> I <br /> i <br /> Does ihe building have a sump pump9 ❑YES (�]NQ Does the building have a grinder pump7 �]YES'�NO I <br /> Storm EveN Oetails: � <br /> I <br /> Where did r�ater entenng building come Irom7 ❑SURFACE FLOW 0 GROUNDIoVATER �SEWER BACKI,P-FIXTURES ❑UNKNOWN <br /> �elails:���Ic��Q`� Vv� �� �'k^��C� Q�rC, r� ' , /�P <br /> Where did wa[er go wilhin Ihe building? ❑BASEIJENT PERIMETER �BASEMENT IJEAR FIXTURES 0 OTHER <br /> Delails: S�'P ��tiotT�. C7.� oT W`+1�P1 ,qA��n �'^e G� C,o�e�e� Wh��Pfs <br /> �.1. j� �n i.� �s pf r� VtS � nC�-Q� <br /> Sile Gbservations: p <br /> Downspoutisilegradingissuesnoted: Iv0 � SSv�j , '"U V`�� ^�__ �X�e��_�111,Q� V` �� ^ (I�l. <br /> Duilding elevalion relalive lo sewer and surmunding area issues noled' �1�'f`�� �`t �e h b �LI G W �fj)��. <br /> Sile pump issues noted: I�' � � <br /> i <br /> Historical Informalion I Olher Intormalion: ! <br /> Previous'Oooding'issue Service Requests al address: �fl ^ e � <br /> � Previous'flooding'issuesnotedbyhomeowner. :" ��� � "��) O�� PJ �v� � �ur �� `1 C�fS � <br /> Recent slorm�valer 1 sewer projecls completed in area: N� ' � Proposed slormwaler I sewer projecls in a�ea: <br /> Property owner inleresled in beginning City Backwaler Valve Program al address:�YES ❑NO Details: W^� h'�`� \n� ' <br /> SfF6�e �roCeG �.�� : <br /> Notes: i <br /> � <br /> i <br /> I R�vision: 3 TNW 1 Thursday, September O5,2013 � <br /> i � <br /> I I <br /> i <br />