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. i <br /> 2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> Dzfe of inspecl�on:_�1/ / ��s- Inspected By: I��! L�T �OUC(r� <br /> C�Y <br /> Fddress 1�C' :�e . Service Requesl Number: <br /> ResidenF. �U-���/T a- OHner7 {�fES Q NO <br /> Phone Number. �' S� � '� 00 Email:_ _ <br /> General Building Detaile: <br /> Is Ihis buiiding wilhin the combined serrer area9 J YES �NO Dces lhe building havz a 6asemenl? YES ❑NO <br /> Does the huitding have a badcviater valre(BYJV)? �YES j�NO (If yes)Was BUJV inslalled Ihra�gh City xogram r]YES �NO <br /> r <br /> Do^_s lhe 6uilding have a sump pumpl �YES�+�NO Does�hc building have a gnnder pump7 ❑YES,�WO <br /> Storm Event Detafls: � � <br /> VJhere did water entering 6uilding come`mm? ❑SURrACF FLOIN �GROUNDWATER SE'+VER BACHUP•FIXTURES ❑ UNKN04V� ! <br /> � / <br /> Dela�is: �OL� �/ .�'Vil✓�_ <br /> ti'Jhere didwater go within the buildina? 0 BASE6'ENT PER�titETER ❑BASEIdENT iJEAR FIXTURES �OTHER <br /> Oetai's:� /1����t,</` /r�� UGi�P�"�P/.R � ' -- <br /> Site Observations: <br /> /�� n <br /> Do�vnspoutlsitegraAingissuesnoted:_�� / Yn l /'11�P���� • <br /> ouilding elevalion relahva lo se�,ver and surround'�.ng area issues noled: <br /> Sile pump issues noted: <br /> Hisroricallnfortnationl0thcrinlormalion: �/_,u�� p,�(,�(,�., vn I/j��� <br /> (Y' i <br /> Previous'llooding'issuo Service Requesls at address: <br /> Previous"Iloeding'issues noled 6y homeownec f <br /> � <br /> Recenl stormrraler f sex•er prajects complefed in area. Pmposed stormwater 1 sewer pmjects in area: <br /> Propedy owner interested l�beginning City�ackwaler Valve Pregram al address �vJ rtS �NO Delals: , '� i�-ti {dl.rt <br /> /� / � r . <br /> Notes. 1ri"�! �ti��/�i'� !1 �V In5 �L�t',l �iln � _ <br /> Revision:3 TRW 1 Thursday,Septern6er O5, 2013 <br /> I <br /> �.: �� � <br />