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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> 477 <br /> Date of inspection: qi/j 4o/20►3 Inspected By: r� per--©/�ry� a�Yr-igrn <br /> Address: Z 4f i e( Service Request Number: ©C71 <br /> Date and time flooding was first observed by citizen: ' Pr (o (I 11 uYN rui..)y1/4 1 i-i yyx> <br /> General Building Details: <br /> Is this building within the combined sewer area? Er YES ❑NO Does the building have a basement? ❑YES ENO <br /> Does the building have a backwater valve(BWV)?WES 181 NO (If yes)Was BWV installed through City program YES ❑NO <br /> Does the building have a sump pump? ❑YES RI NO Does the building have a grinder pump? ❑YES 121 NO <br /> Storm Event Details: <br /> Where did water entering building come from? ❑SURFACE FLOW ❑GROUNDWATER ST BACKUP THROUGH FIXTURES ❑ UNKNOWN <br /> Details: SA J i fl jP i FJ -n)(3_ P9p c-m 7i222(--3 iSTiote, 2 t � � t,✓��-�'� <br /> Where did water go within the building? ❑ BASEMENT PERIMETER ❑ BASEMENT NEAR FIXTURES &OTHER <br /> Details: I5rFLIMC)Q F))lT01 <br /> What type of water entered building? ❑STORMWATER El GROUNDWATER &COMBINED SEWER ❑ UNKNOWN <br /> Details: <br /> Site Observations: <br /> Downspout issues noted:jsansa_e___Zin <br /> Site grading issues noted: <br /> Building elevation relative to sewer and surrounding area issues noted: — <br /> Site pump issues noted: <br /> Historical Information I Other Information: <br /> Previous"flooding"issue Service Requests at address: iti®N6 <br /> Previous"flooding"issues noted by homeowner: NIO )(NAN i S- CiEb <br /> Recent stormwater/sewer projects completed in area: Proposed stormwater/sewer projects in area: <br /> Did nearby areas experienced flooding:❑YES ' NO Details: <br /> Other: 'C2-ter ,4. p r��x�a�1 A�Z mi Q111(p cA.sr-{EI,y Cep ryteC USe5j <br /> Revision:0 11® c--° )T-PxT 'Pnoc Monday,September 16,2013 <br /> wrQ, Main) Fwe.AJ1NCo FINv- <br />