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2013 LARGE STORM RESFONSE PAPER FORM CHEC'rCL15T <br /> Date of inspaction:3������?7 Inspecled By: �=��r}'�=� <br /> Address �-��'%� � r ir�L—=1»��' Servir.o Reque;t Num6er: ('f�17�,bC�"�� <br /> Residenl:_�'�-IQI��i C�i�Q� t��('1/� � O�mer?�YES ❑NO <br /> Phone Number: (U���.�'-iU -hh�;`7 Email: <br /> Generol8uilding Details: <br /> Is this builoing within the comtined seti��er area? Q YES �NO Oces ihe building have a LTsement? �'`/ES ❑NO <br /> Does Ihe building havc a 6ackwater vaNe(BWV)7 ❑YES �NO p(ye�)Was B:VV installed through City pmgram ❑YES Q NO <br /> Dces Ihe building have a sump pump7 �YES ��!� Dces the building have a grinder pump7 �YES �NO <br /> Slorm Event Ile:alls: <br /> 4Yhere did water entering buiiding come Irom? []SURfACE FLOW �GROUNDWATEP �SEYJER BACKUP•FIXi URES ❑UNKNOWN <br /> Delalls: I��Y' �,fr� c �s� �i-12�r�Fy-i ��rnf� '�"7:P,�� ,� �iv-a�-�Q�'� <br /> Where did waler go wilhin me buitding? j�BASEMENT PERIMETER �BASEMENT NEAR FIXTURES ❑OTHER <br /> Details: �"r���'� C��� TI-l�X��1..}—_L—�'''���l� — <br /> Site Observatlons: <br /> DownspouU site gradinq issues noted:�, t �F'1 + ���7r-_��??_nL�C.sJ+Y-G#"� s-�, i b ��f�� <br /> Building eievation re�alive to sewer and surrounding area issues noted: J.�,-� (��_;x �t=_.`-07— <br /> Site�umpissuesnoted: �^-""` ____ <br /> Historical Information I Other Information: <br /> Previous'llonding"issue Scrvice Requests at atldress_��1[' <br /> Previous'llooding'issuesnotedhyhomeo•ener, 1.1C�rJi' <br /> Recent s�ortnwaler/sewer projecls completed in area: Proposed sbrmwaler 1 sewer projecls in area: <br /> Property o�mer interested in 6eginning City 6ackvrater Valve Program al address:�YES �NO Details: <br /> Noles:�Ly�Sj� f�PP�i��=, -�"r-� F-f/�J�- r-!�D �=xx �F •rl_�,�)u'�Lrs'�� <br /> .[4� r-� )t �nrw-� �F.1�(� (-'NS't��f '�Lf` ���ivY�/>P`� G�r,(�Di���(� `'�=�fY1� <br /> TU ���. F�c�m r � �/J C7t�_r'�in� c�N.�r'rt�:t� Td—:�G-�.� ' t ,itix=. <br /> Revision:3 TRW 1 Thursdav,September US, 2013 <br />