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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> � <br /> � <br /> — -- / — — /J/������---- ' <br /> Date of inspectlon: T�`���13 Inspected By: �ti'� ✓ ����"�• <br /> pddress:_ /3/! ��a"��T Service Request Num'xr. <br /> Resident:�iqJ�-0���^`� �� �r7 �YES ❑NO � <br /> Phone Number 7 ZS� Z�G'0 ^ O`f 90 Email: <br /> General 8uilding DeGils: <br /> Is this 6uiiding viahin the wmbined sewer area?�YES ��0 Does the budding have a basemenl9�YES �NO <br /> Does the building have a ba�Jcwater va�ve(84YV)7 ❑YES �]NO� (II ycs)Was BWV insta0ed ihrough Ciy program 0 Ye5�NO <br /> Does the building have a sump pump7 �]YES �NO ` Does the bu:ld ng have a grinder pump7 ❑YES (�'NO <br /> Storm Evmt Ddails: <br /> Wheredidwa�erenteringbuildingxrnefmm7 r]SURfACEFLOW �GROUNDWATER�SEWER6ACKUP-FIXTURES �UNKNOWN <br /> �]etails:f/� �s�!'1.,���� LG�s/Ll✓ �/?A+31 <br /> Where did miler go within the building7�BASEMENT PERIMETER�,BASEMEIJT NFf,R FIXiURES ❑O7HER <br /> 1/ / p / <br /> Delai!s: WQ/(' � ' 4.�1����`"�Y�O <br /> SHc Obscrvatioin: <br /> Downspout 1 sile grading issues raled: ��T /tF 7"�� <br /> Buifding elevalan relalive l�se«e�and surwunding area issues noted: <br /> Sile pump issaes noled <br /> Historical Inlortnalion I Other Infortn�tion: <br /> Previous'�ooding'iuue Servre Requests al eddress: <br /> Previous"flonding'issuesnotedbyhomeawnec z��d <br /> Recenl�tormw�ter 1 seN*�r projecls rompletcd in area: Proposed stortnwaleN sewer pqjecls in area <br /> Properry owner interested in begnning City Back�rater Valve Program at address�YES 0 NO Delails: <br /> Noles fl8 'nar+lt�C( 1��►t e�"q�V ���A �tn tllartnB/stie �/Yi�/1l _ <br /> � e� � �� /" <br /> snsfir�('t' �kN fwe„ <br /> Revisian:3 TRVJ ] Thursday,Seplember O5,2013 <br />