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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> '74,1-7‘ <br /> Date of inspection: q/5 // ? l ( 4-41. Inspected By: (J'( t,1 Pao lht 370, ,AdAd/'t <br /> Crr,c y f3roki <br /> Address: (6 f S-Nt ' 1 4V _. • Service Request Number: <br /> Resident: iN/V d-, S Owner? EKES ❑ NO <br /> Phone Number: Email: <br /> General Building Details: <br /> Is this building within the combined sewer area? 'S ❑ NO Does the building have a basement? ES ❑NO <br /> Does the building have a backwater valve(BWV)? YES ❑NO (If yes)Was BWV installed through City program IFK:ES ❑ NO <br /> Does the building have a sump pump? S ❑NO Does the building have a grinder pump? ❑YES 2<10 <br /> Storm Event Details: )✓ 0) C Yllet <br /> • <br /> Where did water entering building come from? ❑SURFACE FLOW ❑GROUNDWATER ❑SEWER BACKUP-FIXTURES JNKNOWN <br /> Details: 4??2 .4-5 t --?"7—Q{.¢ot f )v'kk 1 Z ULX' pr%do, <br /> Where did water go within the building? E'gASEMENT PERIMETER R4ASEMENT NEAR FIXTURES ❑OTHER <br /> Details: f%A �10- (34L,€M a/r- ,‘. <br /> Site Observations: <br /> Downspout/site grading issues noted: '1 <br /> 1•°: /Libeiree& <br /> Building elevation relative to sewer and surrounding area issues noted: Fr&Try Get r imroti • <br /> Site pump issues noted: a p Il;,/1-ev, /3 D�/t J Gt Wac.- .7 1,v jj CleGtm ( th <br /> Historical Information I Other Information: [ <br /> Previous"flooding"issue Service Requests at address: (Atilt. OR c TU`ivi - <br /> Previous"flooding"issues noted by homeowner: 6l j 11 p <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: ❑YES ❑NO Details: <br /> Notes: or t`& (3' ' (-G'v Gt c1 c t?( v t rQ &t Pi& ? j,"` Gut fib le—. <br /> (-0 k ,J/ k' r - p alt ,t T� � 13 a' c- <br /> c (aeMair ilmrS <br /> Revision: 3 TRW 1 Thursday,September 05, 2013 <br />