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2013 LARGE STORM RESNONSE PAPER FORM CHECKLIST <br /> — ----— �'! /lv /j -- -- —�ns ected B ��✓t 6� �'�i�e r i!/f. -- -- <br /> Datcolin�;.ection: P Y--� <br /> Address �`�V 1 l�'U t/� I�✓r'f �41�L2�lS.�. �m�Reaues!Numher <br /> REs�dent�.�u,L��•+nn �.pPr _ Oa�en��YES �NO <br /> Pnone Num�er `f 2.5" -� 317— �f 03 ��� <br /> Geaer,:l Building Details: <br /> Is th�s bmldmg witnln tne comb�ned sewer areaT �YES ❑NO Dces the bu�lding have a baseneal7 �YES ❑NO <br /> Does the huJding have a ba:k�+�atzr valve(BVJV)? ❑YES ❑NO � (II yes}V`Jas BVJV�nslalled thwugh City Progiam �YES �I WO <br /> Daes tlie bw!ding have a su�o Fump� ❑YES�j NO Does the cui!Cin3 havc a gn❑aer pu��7 ❑YES �k0 <br /> StormEventDetails: ,flk� 2( � �P�'h 5/�' <br /> Ydncrc d�d�5atcr emenng 6m!d�r.g wme from? 0 SURFACE FLOW ❑GROUN�'�NA7ER�SL-lY�R B��CKUP•FIXTURES ❑UVKKOLtiN <br /> Delails .s�uw+^ d(uk G'�.d �Z� — <br /> 11'here dld v.�aler go x�thm lhe 6u��fdmg7 �BAS[I.i[NT PERlh1'eTER �BASEMENT N61R FIXTURES ❑OTHER <br /> 'a `/ i� „ /// <br /> Details�._�D� !jO �7� �'��� � �- `-f-��__ ---- <br /> Sile Obscrva[ions: <br /> Dovmspout 1 silc 9r,dmg�s�s:s nnted �j(�n F — - <br /> Building elevalion rela6ve lo serrer and surroundmg arca issues noled: - <br /> SAe pump issues nNed: — -- -- ---- - ------ — <br /> Historical Intormatian I Othcr Information: <br /> Pretious'Oooding'issu^Scrvice Requests at address _ ----- �-- -- - <br /> Previous"flooding'issuesnoled by homcowncr_ ZDIO ___ _. -_ ._ . _. . —. <br /> Recent slormvnter!se�ver orojects crompleted in area Pm{wsed slormv�ater 1 se�cer pto;ecls in area _ <br /> Pmpedy mmennlereslcd in beginn�ng C�ry Baaiva;eNatve Piogram at addmss�YES (]�0 Oelaits. <br /> Nores ��/M�P� fGti^'P P��"f�.—.rh G' Z U12t�L� Aibrf _ __ <br /> _13r� eu/V �.����.r � �l�f.�'Ii_��-r��j <br /> J s s�/ 'h .�r•a.�o� �r��i1L� ��, �o � ,�� a ��%� <br /> Revision: 3 TI1W 1 Thursday,Septemhcc O5, 2073 <br />