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_ _ . , , . . : _ ._ ,: . . <br /> .. .. . - _ _ . . . <br /> _--.. I; <br /> 2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> Dateofinspeclian: �' ( � � -} Inspected8y:���fn (! _ <br /> Address: 0'U�}� RUfh�� ServiceRequesWumbec <br /> ResidenL• OHner7 �ES ❑NO <br /> Phone Numher. Email: <br /> Gencral Building Delail:: - <br /> Is Ihis building within lhe comhined sewer area? YES 0 NO Daes Ihe building have a basemenl? YES �NO <br /> Does Ihe building have a backwaler valve(BWV)? ❑YES � (It yes)Was BWV insWlled tluough City program �Y[S.�J NO <br /> Dces the building have a sump pump? ❑YES NO Does the 6uilding have a gnnder pump7 �YES [�10� <br /> Storm Event Delails: <br /> Where did water entetlng building come from7 �SURFACE FLOW �GROUNDWATER SEWER BACKU?-FIXTURES ❑UNKNOW� N � <br /> Details: U� ��1� !� ��a�l.ti4 � (f(�i/�7tif ��1�1`� e- c n '�'I/fGG�� �L'L��n!� $i�/���• • � ��5� <br /> Wheredidwalergow�lhin;hebuilding7 QE�SEMENTPERI�tETER BASEMENTNEARFIXTURES DOTHER <br /> Delails: I—�?�i��'` ��C� j"��'�1 /' ' <br /> Site Observalians: <br /> ,L 'r [dija��l e�' <br /> Oownspout 1 site grading iss ues noled: Gf - <br /> Buiiding elevation relative to se�ver and surrounding area issues noled: <br /> Site pump issues na�ed' __ _ <br /> Histarical Information I Other In(armalion: <br /> Previous Yloading'issue Service Requesls at address: <br /> � Previous'flooding'issuesnoledbyhomeaaner���0 S ✓' k�lL dn� •f-[.7u/LG��1�¢<��'� - � <br /> iReceN srorm�tiater I sevrer projecis completcd in aree: Proposed �vater I sevRr p%ecls in area: ' <br /> � Propedy ovmer�ni. :sted in 6eginning Ciry Backwater Valve Program al address: YES [�NO Del�iis: � <br /> � p i <br /> � Notes: .� I,ltl S- (1�f 2-� ��l�A/� _ <br /> , � <br /> � <br /> i <br /> f <br /> I Revision:3 TRW 1 Thursday,Septcmber O5, 2013 <br /> i <br /> I <br /> � I <br />