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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> 477 <br /> Date of inspection: (©7)-3/ ( 3 Inspected By: (Jl/G r, i 0 ei/4i. <br /> Address: / O G . N path TT Service Request Number: <br /> Resident: Atol(i G- f�G,(,t.( ji,c [ 'Owner? YE ElSNO <br /> Phone Number: 9-o 6 4j4 hi- `�(')It Email: <br /> General Building Details: <br /> Is this building within the combined sewer area? ❑YES NO Does the building have a basement? �I YES ❑NO <br /> Does the building have a backwater valve(BWV)? RV'ES ❑NO (If yes)Was BWV installed through City program ❑YES L U <br /> Does the building have a sump pump? ❑YES NO Does the building have a grinder pump? ❑YES 12110 <br /> Storm Event Details: <br /> Where did water entering building come from? ❑SURFACE FLOW El GROUNDWATER SEWER BACKUP-FIXTURES ❑UNKNOWN <br /> Details: /1,L, et , 13t4 ,I / <br /> 113. <br /> Where did water go within the building? <br /> c BASEMENT PERIMETER BASEMENT NEAR FIXTURES ❑OTHER <br /> Details: -Q!l, 7( r .X.-e---pcl.a-A, / 7 <br /> Site Observations: <br /> Downspout/site grading issues noted: DOfn-n S zaa--S ei p-a_// /0 IA`/l l'l noh 4 <br /> Building elevation relative to sewer and surrounding area issues noted: G.(i'i y(,er1 d/( ae5 0 if (fi 1---0 8Ati , <br /> Site pump issues noted: <br /> Historical Information I Other Information: <br /> Previous"flooding"issue Service Requests at address: <br /> Previous"flooding"issues noted by homeowner: <br /> Recent stormwater/sewer projects completed in area: Proposed stormwater/sewer projects in area: <br /> Property owner interested in beginning City Backwater Valve Program at address:E2t<rEs ❑NO Details: <br /> Notes: [ 2 F 0 814t ;P/I✓Q / . t h 7 fr yf5 Gy <br /> Z(in (/- &?-0.1 -e p`,s z�,c l3'I,.A/ <br /> Revision:3 TRW 1 Thursday,September 05, 2013 <br />