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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br />4M7r <br />Date of inspection: q/� Inspected By:oY/!s A , C'I <br />Address: Z ,YOcf L?,IN •0 AV t Service Request Number: Doti 1 r% i.S— <br />Resident: IQtlA) 6y'eV OwneO []YES ❑ NO <br />Phone Number: Z�J S • .) I o— 590 Z Email: <br />General Building Details <br />Is this building within the combined sewer area? BYES ❑ NO <br />Does the building have a backwater valve (BWV)? ❑ YES KNO <br />Does the building have a sump pump? ❑ YcS `VrNO <br />s'6,-r o >- <br />Does the building have a basement? 0 YES ❑ NO <br />(If yes) Was BWV installed through City program ❑ YES RNO <br />Does the building have a grinder pump? ❑ YES WNO <br />Stamm Event Details: <br />Where did water entering building come from? QrSURFACE FLOW ❑ GROUNDWATER 2XSEVVER BACKUP- FIXTURES ❑ UNKNO'MI <br />Details: <br />Where did water go within the building? 216ASEMENT PERIMETER 9�9ASEMENT NEAR FIXTURES ❑ OTHER <br />Details. <br />Site Observations: // L <br />Downspout / site grading issues noted: F 62 ' LD i S <br />Building elevation relative to sewer and surrounding area issues noted: _ <br />Site pump issues noted: <br />Historical Information I Other Information: <br />Previous'800ding' issue Service Requests at address: <br />Previous *flooding' issues noted by homeowner: /Y 0 P -L <br />t/-,j! ) t:�" <br />Recent stormwater / sewer projects completed in area: Proposed slormwater I sewer projects in area: <br />Property owner interested in beginning City Backwater Valve Program at address: LYES ❑ NO Details L <br />Notes il r�� Q t S �it^i S / 9-� 1N (/ I-//G (6 e lJ <br />a��I �Ile <br />Revision: 3 TRW 1 Thursday, September OS, 2013 <br />