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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> Date ot inspection: ��C�i jiL�l�� Inspected By: �i:=,mE�'� ��r�_c.7�f <br /> Address: �1 I (: 1-1 yr � iTY Service Requesl Number. f:�1 ??��t3'� <br /> ResidenC '�tir='��-4--���QjL.L Owner? �YES ❑NO <br /> Phone Number. ��l f-���'�f� • �r=�C'�'�'. Email: <br /> (N�h� 'Z�2 '�7 i I(v <br /> Ge�eral Building Details: <br /> Is Ihis building within Ihe combined sewer area7�YES ❑NO Dces ihe building have a basement? �YES �NO <br /> Oces Ihe b�ilding have a backwaler valve(BWV)� �YES �NO (I(yes)Was BNN installed Inrough Cily program 0 YES ❑NO <br /> Does Ihe huilding have a sump pump? ❑Y'cS �NG Dces Ihe building hnve a grinder pump7 �YES�NO <br /> Startn Event Details: <br /> Where did water enlering buiiding comc Irom?�SURFACE FLOW 0 GROUNDWATER�SEWER BACKUP-FIXTURES ❑UNKNOWN <br /> Oelailr [.JLYfi9 1 - . � •. � . � - =��1 �"'�•�C'rLYi-�� <br /> (�'� Wc:LL L�� i/�C:Xi•� Vn IN rOif.,rT ( G�Ti-�'rU <br /> Where did water go within Ihe building? �BASEh1EIJT PERIMETER ❑dASEMENT NEAR FIXTURES�OTHER <br /> �etaits:l'-�w_r, -�?-! Lf�IEL t=L'r��Vt t^e_rG�O TI-I,�'✓�c w.1� (�a>^!w/� /-►('��L �N'(� <br /> UF-��[x. �jn/_�..is nr.�L� C:v, i=L'uvT CX:r1rL.• <br /> Site Obsenations: <br /> Downspoul/sitegradingissuesnoted: �=/�G' (-PAt7�NF Lr :� "'-, �4P(�����3i�'��nk_, �y�_'_��.,.-�'1YJ.ilt•�. <br /> Building eleva�ion relalive lo sewer and surrounding area issues noted: <br /> Site pump i�ues notedr ` <br /> Historical Information I Other In(ortnalion: <br /> Previous'Aooding'issue Service Requesis at address �k��1r`. <br /> P�evious'liooding'issues noted by homeowner: f.ii,r,.�. <br /> Recent stoimwaler 1 sewer projects wmpleled in area. P�oposed slormwater f sewer projects in area: <br /> Property owner inleiested in beymning Cily Backwater Valve Propram af address;�YES []NO Delails� — <br /> Noles�Jy)!]�r�L �i`rFl�r:� �i ���f7�NE- V�l� ��CJFfx� �Llzti) l�rJ�"'� �i Wc0 <br /> �z^_'�L UO "-rt!' x](�•F4 GIYTLiL'��, 1 )n�vwir� �1�-) rlr� J til C_ri F�c-�r'li.`��. <br /> wrr� rn�r:n R-I :�::A�p �ec�i � ,P nrv�� �u:�,J ,'Y��•r� Wr��-�(��� _ <br /> TG INA�GUP��i' NGJGX�l3� 't�IVP�(� 'J��iNr'�.c' ir.� �i:pL' oG <br /> Revision:3 TRW 't���'W�• 1 Monday,September 09,2013 <br />