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��y;ry� 2013 LARGE STORM RESPONSE PAPER FORM CHECKLI��T <br /> DateofinspeMion: � � � Inspected3y: �/QVL°� Y• �iK��� <br /> AddTss� �/S� �K[.�!✓� ServiceReauestNumhec: <br /> ResidenC(11ya1y�_� r r� sy� /� Gr'L . �T� O�mer1 �YES �ND <br /> �• � 6 � <br /> Phone Number. 8�' ' ST10�'7��`7� Email: <br /> General Building�etails: <br /> Is this building v.ithin the combined s=wer area9 (�$YES 0 NO Dces Ihe 6uiYJing have a basement� �YES 0 NO <br /> Does ihe Guilding have a backwater valve(BYJ1�? �Y[S �IJO (II yes�Was BIVV inslalled Ihragh City program ❑YEo �NO <br /> Does the bui:ding have a sump pump7 �.YES �NO Does U�e bullding have a gnnde pump? �YES,�J NO <br /> StortnEventDetails: Aa� 2-�j �i�...� ,�,� S� <br /> Where did water enlering 6uilding comc irom? ❑Sl1RFACE FLOIN ❑GROUNDWATER �SELVER BACKUP•FlKTURES �UNKNOWN i <br /> Details: �� ��7�G/i ��iBl.t.T/�' <br /> i <br /> IMieredidwatergowilhinthebuilding7`��ASE�dENTPERIMcTER �BASEMENTN�FRPIXTURES ❑OTHER <br /> Detailr L!�ltl���— � /n�� l F� [ltC.O <br /> Site Obscrvatfons: <br /> Do•,vnspout I site grading issues noted: 3 LY�'h r1F�� Q.eT6/ZC1� YrJ 7D�j'��i�� �: <br /> �vilding elevation relative la sewer and surrounding area issu^s noled� <br /> Site pump issues noted: ���K� �^"f�y. �OG, U�������`'� ���N� f 4 > ,(�J`' <br /> Historical Information f O�hcr Information: <br /> Pievaus'lloodin9'issuc Senice Requesis at add�ess:_ <br /> Previous 9loodin�issues noled hy hameavmcr. <br /> Recent stormwafer/sener projecls completetl in ama� �Pro�psed slortmvaicr!sewer�•ojeds in area: � <br /> Pmperty owner inlcrested in hec�inning Ci,y Bac4water Va��e Prognm at a�dress:�YES �NO Details�. <br /> Notes: K�'Md'+`/' ."rdNP.I tnti� y"t.t4�s(Yl�ti . LM /YOCi1^f G/�Q �.UZd/�. <br /> __�f1'}�� � - � �i� <br /> i <br /> �i1a_;n r ; Pr� �s�n v �� yrv�. <br /> Revision:3TRW 1 Thursday,5eptembcr05, 2013 <br />