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2013 LARGE STORIVI RESPONSE PAPER FORM CHECKLIS7 <br /> Ev <br /> Dateo�'mspnclion� `f /i - - - InspededBy. /',an�� Dasrf� : �� . iti,.��i�., <br /> n - <br /> Address. 3 ! i 4 L c.� G�7 c.� Service Request Number r':� ' � .1 i.; ' . O u�2?:;\�Z <br /> „ !�, <br /> �Fr✓ ♦ 5�'1 S <br /> Residenf "Lllrec��; ;.!=�r:��. _,,�:n .,.>� i�=���.."�,.^.�, � C�vner7 DYES �NO _ <br /> � �. <br /> PhonslJumber. .�C� (�,C-v U'a�J � u�.> �V77 -�� fu °- _�mail 7'ic%'�:�%(_.`=�lt�rs:l�=✓ e:.";,., j -.,�,r'�� <br /> General Building Details: <br /> Is Ihls bwldmg r.�thin Ihe comhinetl sewer area9�YES �IJO Ooes Ihe building have a basement?�YES �4:0 <br /> ! � <br /> Coes the bwtdmg have a backwater va!ve(BWV�? �YES ❑NO (if yes)Was BPlV inslalted through C�ly program ❑Y"eS '�^�;'0 <br /> c7C ,uC'T �rCjOP / <br /> Does the bwlding have a sump pump? �YES 0 Does Ihe bui!ding have a gnntler pucp7 ��,]YES [��'�J <br /> Storm Event Details: <br /> bVherr,did vreter entenng 6ui!ding came lrom? �SURFPCE FLOW �GROUNDW'ATER C �';d�K BF.CK�?-F�,X7UR.E5 ❑ UNKIJOL'Ji� <br /> �BIBiIS �.RD�v ��l�1�C 1" F� TJr _ V"1 1 I iU �H N/L`i[• " 1 �ti � ,u.� _)_, ;�'S � � L <br /> 4'lnere did water ao wi!hin ihe ba�!dir.g� ❑�ASE��1EtJT FERIFdETER SEMENT N[AR FlXTURES �OTHER <br /> �8181�5: ,4:0�� �� �1J', ti� 1 ��� �f<<. i ____'is .i�r.�--.. .��._ ,,ia� O,'j.� <br /> -- � i <br /> $itC ObSCNdtiO'I5: <br /> Do�,vnspouf I sAe,radmg issues rotcA _��_E,r','c:.',-• ---- <br /> �ui'd�ng elevation rela6ve ro sewer and surtounding area issues noled: (-� �r'�: w.�i�^ /�r J C �/ <br /> Si�epumpissuesno;ed�. __________._.__ _. --�--- <br /> Hislorical Information I Other Inlormation: <br /> Previous Ylooding"issue Service Requtsts at�.^,nress ____.___ _____________. <br /> Previous`floodmg"issues noted Gy homeownei. �-✓��' t�f-•�h�t�"� , rL ? i�c �/ <br /> Recent stonnwaler/sev:er projecls complefed in area Propose slormNaler/sevrer projecls�n area <br /> Propery o�mer inleresled in beyinning City Backwate�Valve Program at address' YES []NO Delails� _.. <br /> Notes:�ll'cX � /J y�(y� p �c9Nc� FlPu�T /l�l-�vy r�llt�/�J ���c.1✓� �,',�,' �' <br /> � <br /> N� �5 � ((� ..t :f�IEK vN.\5 (y{C . .l 141�N�' ��... tq���_��.- n !._j...,..,c_ �tf.�._. . <br /> � 1 L/1l l" O, iC vS) .�.. 1�, o� �: <br /> ftevision: 3 TRW 1 lhwsday, Srp[ember O5, 2013 <br />