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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br />N�,-.� <br />��`�f�� <br />Dateo(inspection: ��b-�_� InspecledBy: (�/L�--�'� /�-���/1 <br />Address: Y7.�iv ��Vt)6r�6T .i�2 Sen'ceRequestNumber: <br />Resident: ��44� VU.t1ni�( �-►"IL%�ea� Owner? �YES ❑NO <br />Phone Number. 'I a S' r�5 c� � SgI 3 Email: _ <br />Generol Buliding Details: <br />� <br />Is lhis huilding wilhin Ihe combined sewer area7 � YES NO <br />Does Ihe building have a backvratcr volve (BWV)7 ❑ YES ❑ NO <br />Does Ihe building haVe a sump pump? � YES ❑ NO <br />Storm Event Delails: <br />�,..�1�5`� �le�^�'t <br />Does lhe buil�ing have a basemenl? �YES ❑ NO <br />(I( yes) Was BWV ins�alled Ihwugh City program ❑ YES �0 <br />Does the building have a grinder pump? � YES � NO <br />�Vhere did waler entering building wme from? ❑ SURFACE FLOW ❑ GROUNDWATEF � SEWER BACKUP - FIXTURES � UNKNOWN <br />L \ 1 �� <br />Delails:��C(r� M�. G J� 1� fu �„ ti`� "1"� S�-u ti� � �� � �2 L41e l�-r��' -���QO.� �v� <br />v <br />Where did waler go �vilhin lhe building? ❑ BASEMENT PERIM1IETER �ASEMENT NEAR FIXTURES ❑ OTHER <br />Details: 7� ��� u'� �' �•. la i( rA� � p,� �i/Z GI �^ e �� �"� <br />Site Observations: <br />Downspout I sile grading issues noled: S�'„' Q, �`S�� ^ <br />Building elevalion relative b sewer and surwunding area issues noled: <br />Site pump issues noted �n O� U r-' � S• <br />Hislorical Iniormation I Other Information: <br />Previous'Ooodin�' issue Service Requesls al address: <br />Previous'llooding' issues noled by homeowner. i�0 L' <br />� Sav--e V „�cv.o�.. <br />I�ti�� k•,�.r.,_t �Plc�_ I �� <br />�p,.,e�✓..p( b�J..!X 1Ur ,i <br />Recenl stormwaler I sewer projecls compleled in area: Proposed slormwater 1 sewei projecls in area: _ <br />Pmperty owner interested in beginning City Backwater Va1ve Program al address: ❑ YES ❑ NO Delails: <br />Noles: C-"`C,•-•�• ��`"� OF l_.1 (� c��ly c�Ph '� v?� 70rC�. ►JO�nI'�''�� �� <br />`i <br />Ow.y �..�� A.S CD^nCG`P�. <br />Revision: 3 TRW 1 Thursday, September O5, 2013 <br />�PC� C� � <br />— � <br />