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2013 LARGE STORM RESPONSE PAPER FORM GHECKLIST <br />�v <br />Da��o'inspecfion:l �2�/ � InspectedBy: I.1( /( + r �. � �' <br />Address: yQ� r'� � r��' _-- — 6ervice Zequesl Number: _ <br />/� <br />Residenl: � UUI�s�� C"I�� Owner7 �YES ❑NO <br />Phone Number: <br />General Building Dntails: <br />Is this building viilhin Ihe cor�bined sewer area? ❑ YES �NO <br />Does Ihe building have a backwaler valve (BW�? � YES �NO <br />Does Ihe huilding havc a sump pump9 ❑ YES � NO <br />Storm Event Details: <br />Ema:l: <br />Does Ihe building have a basemenfr �YES 0 NO <br />(II yes) Was BWV inslalled Ihrough Cily program ❑ YFS � NO <br />Does the building have a grinder pump? ❑ YES .� NO <br />Whcre did water enterinc� building come hom� 0 SURPACE PLOW ❑ GROUNDWATER U 5[WER B�CKUP • FIXTURES � UIJKNOWtJ <br />I —b <br />Details: ;°�' � E� � <br />VJhere did waler gu within Ihe ouilding? � BASEMENT PERIN�ETER j�BASEMENT NEAR FIXTURES ❑ JTHER <br />Delails: ���. - � �� r��ti � .— — <br />Site Observations: <br />D,ie�nspcut I sile grading issues noled. � �n _J� ��_ �9� T�' '���� <br />8uilding elevalion rclahve to sewer and surrounding area issues noted IS �%W �v l%? "'�� _ <br />Site pump issues aoled. <br />Hisloric.l Inlormation I Other Intormalion: <br />Previous "flaodmg" issuc Sr.rvice Requests al address: <br />Previous "Iloodin�" issues noled by h�meovmec ��1� �• <br />Recenl storme+ater I se�ver projr.ds compleletl in area' �U Proposed stormvrelnr f sewer prejr.cis �n area �_ _ <br />P opedy owner intcrested in beginning City Backwater Valve Program at address �'Y[5 ❑ NO Details: __ __ <br />Noles 1Y����t�� I�1 1 S(�/L��� %�'1GtG�^S �� S/(/�M �-S /�i� LV �%.��•_ <br />Revision: 3 TRW 1. Monday, September 09, 2013 <br />