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E' <br />2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br />� � <br />�� <br />Dale ol inspection:_ � L 3 _ Inspected By. V rQ�rl.,'�— �.t��� <br />Address ����1 '�-ti. 6 Service Request Number. O U (� �� <br />( <br />ResidenC ��9��� '�=C� _ Or+ner? ❑ YES (]� D10 <br />PhoaeNumber: ��:�^ —�3��_1�2� EmaiL L{� f{%ll \U�'\Vl � 0(0�. �ll'\ <br />, Geuersl Building Oelails: / <br />I Is Ihis 6uilding wilhin the combined seeier area? u YES n tJ0 <br />i , <br />. fJoes Ihe building have a backwater valve (BVVV)? �eS NO <br />Does �he building have a sump pump? 0 YES �,{rd0 <br />Storm Event Details: <br />Docs the building have a basemenl? �ES [1 NO <br />(It yes) Was BWV installecl lhrough City program L1 YES � t� <br />Does Uie build!ng have a grintler pump? �ES Lp' �JO <br />l'Jhere did water en�ering building come Irom7 ❑ SURFACE FLOVJ ❑ GROUNDWATCR U SEINER BACKUP - FIXTURES IV_I UNKNOWN <br />Delzils' T�.Ir�f �t �in/`,e � lo�� �0� 1C'� � �C<<h-lr��j'Yl(� i f l.��(' ^^a)�r �C��r� ��•,�� .._ <br />r�.a$ 6�{ 1Co�—�--l�l v2�� ve �n �,ot U r,J,— ��,y �,.�,� �.(., l.o.--Z Fror�. <br />l N h e r e d i d n a l e r g o v � i t h i n I h e b uil di n g? 0 BASEf�1ENT PERINFTER [�BASEIv1ENT NEAR RXTURES �L1'OTHER r�'fD •�. <br />IvC f � n Pel.�'Lr„1 <br />Details: ����i G1'�'4 �r�in5 i-D r�..�.��f <br />�ru,�S �v �jr,,,����-� i'�.;h�.) lo�c� -� <br />� , � �.� �'� '�s L ,,� �, ,, „ � <br />�� � (� r C I Q. <br />, Sile 06scrvations: �� �„X r„� � ` ((�� <br />� Downspoul l sile grading issues noleA: � J V^) T� V� I �� n� ���1� �� k'^' � V' , N� '� (�'J �°� E"" <br />�uiiding etevalion relative to sewer and surmvnding area issues noted �� S_-L�- �^ ��/���o' S ��' se�v "� r'�'� 5' "�C !\I <br />1 V __� �,�_/ �, / <br />S!lepi�mpissuesnoted�. NU `1SUNS ('XLe�I''- N('�.. �O�y ^��� ro^•�eC��� ilJ v `��r`;�� ) <br />Historical Information I Othcr Information: <br />Previous "Ilooding" issue Service f�� {�esis al address: <br />Previous "Ilo�ding' issues noted by homeowner: /'�S -t-� h 4� S��^^ ��� �� ��. � C <br />�iV h �Cll�t e.r�[n�f , <br />Recenl stormwaler / sewer projects mmplefed in area: N �—� Proposed slonnwaler 1 sewer projecf, in area: <br />Property o�vner inleresled in heginning Ciq� Backnaler Valve Program al address � YES � NO fletails � _ � <br />�ZS .. �`i�1— U�� ��o^�u�� a���L`�'�U , <br />�am„�� r � <br />�1,���� Sw—��-�n�e � � c�� �� �-- rC c. � u� I o,,..cr loo r <br />� •\�Y1f�� ll� �����—�—r'/t��.�'0 `\LL`��� �� ^�1`'1 ��f. �li���"�'� <br />1 <br />1,.�� lo,�,r ��\. �'��e- r�� sv r��.c�.. <br />Revisiorc 3 TRW 1 Thursday, Septeinber O5, 2013 <br />