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i <br /> F <br /> i <br /> � 2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> ��� ' <br /> Date a(inspechen�.,_ %/� /3 --- �� Inspected By_y! ✓f �----��k /�� � ------ <br /> tida�c�5 ___/3 i'T I � " z7��lfr. SendceRequestNumber: __— <br /> Resident:_/Jf'TS C�� ���� _.— OvmeR �1'c5 []NO . <br /> f'honeNu,mbe,� z S .'=��_U_� �o �' Email: � <br /> General Buildiny Details: <br /> Is Ihis huilj�ng vn�hin lhe com6ined smver area7 �`(ES ❑WO Does�he 6uilding have a baserrent? �YES []NO <br /> Does the building have a tackwaler valve(BlN�7 `]YES �NO (If yes)1Vas 9VJV inslalled Ihrocgh Cily program ❑YES �Q NL` <br /> ' Does the building ha•ie a sump pump? ❑YES [�}-I�'0 Does�he building have a grinder pump? �YES (�I�0 <br /> q Zi ��o F/o��� S'.��� r/F) <br /> Slorm Evenl Details: u,.} � <br /> v <br /> l'lhere dld vralerenleiing bwlding come Gom7 ❑SURFACE FLOW ❑GROUNDWA7cR�SLl'dER BACKUP�FIXTUR'eS []UIJKN04'JN <br /> Delails�.� !� /J ��LY� S/'�11/f•� - -- <br /> l'Jheredidvratergotihthinthebuilding? �BASEIdENTP[RIMETcR�IRASE1dENTNEARFIX7URES ❑OTHER <br /> o�,,��5 ��/- � —w�l/ 3 " �1 <br /> Sitc Obscrvations: <br /> / i / �L// <br /> �ovmspoutlsite,qr2dingissuesnoted:o2 u,'e✓L �'til1f�-Itt� �C 27 �o�'a!'- �Ov�x�Ei7^"�__��- <br /> �u,lding elevation mlative to sewer and su«ounding arca issues noled�. <br /> Site pamp issues noted:_ - <br /> Historical Informalion I Other Intortnalion: <br /> Previous'flooJing'issue5e`vceRequesisataAdress�.___ _ <br /> Previous'Ylooding'issucsnotedbyhomeowner.,_ Zn�� ___ -- <br />� Recent slormvr�ter/se�aer proiects compleleJ in area �'roposed slcrmwzter i sewer p�qjects in area: <br /> Propedyo+nerinleres�ed in 6eoinni�g City�ackv+ater Val•ie Pmyram aladdress:�.YES IJ iJ0 Datails: <br /> Notes: �[✓ ✓ r/P�PC{� � / <br /> __Qcu,l.�.�ia�-v�l•1 �' � Yr _/�r�P� %rA*r/tlj� -- <br /> Kevisiou�.3 TRI�� 1 Thursday,September O5,2013 <br />