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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> Dateofinspeclion: -�1�17 �� OI:� InspecledBy: �j_���4' �1�/afL N!_�M <br /> � <br /> Address: �77 ��ir,v.l Service Requesl Number. <br /> Dale and time flooding was first observed by dtizen �j I�C/ �7['�I� l(7 '(��C� PM <br /> General Buitding Details: <br /> Is Ihis building wilhin Ihe combined sewer area7 ❑YES �Q NO �oes the building have a basemenl? �YES ❑NO <br /> Does lhe huilding haue a backwalcr valve(BW�? �YES �NO (It yes)Was BWV inslatled fhrough City program ❑YES ❑NO <br /> Does Ihe building have a sump pump? �YES�NO Does Ihe 6uilding have a grnder pump? ❑YES �NO <br /> Storm Event�etails: <br /> �Yhere did waterentering 6uilding come from7 ❑SURFACE FLOW �GROUNDWATER ��ACKUP THROUGH FIX i 7RES �UNKNOWN <br /> Delails: 1.�' !]fY_ [�r Ti-���� ��-' �Noi.�A=� ��—Y1LL <br /> Where did wafer go wilhin the buiiding?�BASEMENT PERIMETER ❑BASEMENT NEAR FIXTURES�OTHER <br /> Delaits: LJ(Yh�i- r�-..��7� �_y cr,�ix'z�YIF,Ji='_v.�ir1-r c..�L�T�� <br /> 4Vhat typeof water ente�ed building7 19 STORMWATER ❑GROUNDWATER ❑COMBINED SEWER ❑UNKNOWN <br /> Delails: WRs'i,� [v�vtc Ti-�4l�uh H �� �_�Xr`��'� n 7� G,F'9c32� �a�::L <br /> ��G-r✓l�0 U V-t �'r�V1�1 WfsJ6Q, <br /> Site ObServations: <br /> �wnspoulissuesnoled: �i�-� i�r'n j=rv — �� )7 � rn� � ' ) µ,rJM�...�F�Tirxa A-���"� <br /> Silegradingissuesnoled: � ��. <br /> Building elevation relalive lo sewer and surtounding area issues noted:_ <br /> Sile pump issues noted: <br /> Historical Intormation!Othor Information: <br /> Previous'flooding'issueSenrceRequeslsataddress: � �nn1G- <br /> Previous'�ooding'issues noted by hameowner. �����,� <br /> Recenl slormvrater!sewer projecls compteted in area: Proposed slormwaler 1 sewer pro�ecls in area: <br /> Did nearby areas experienced flooding:❑YES�NO Delails: <br /> Olher: I �r�n�<,T�"4� inJ 'r"'�F�G.�..>A^�� �cv ,� <br /> Revision:0 1 Monday,September 16,2013 <br />