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2013 LARGE STORM RESPONSF PAPER FORM CHECKLIST <br /> Date ol insp�ction: �1 – `l— /3 ��n /+� Inspected By: D Vo"�S'� <br /> Address: �S//.�i.ic�fr ��`f rs �%T�y GAF�kervice Request Number: y <br /> ResideN: l�P1(N dN� IH�/wli �a /7 �Y'rr Oxner? �YES 0 NO � <br /> Phone Number: Email: <br /> General Building Oetails: �i <br /> Is this building wiNin the combined sewer area� [�YES �NO �oes the bui;ding have a basement? �YES ❑NO <br /> Does ihe building have a backwaler valve(8N'�? ❑YES �NO pl yes)6Vas BWV installed Ihmugh City program �YES �NO <br /> Does the building have a sump pump? 0 YES �NO Dces Ihe building have a gnnder pump? Q YES�NO <br /> SrormEventDetails: �� z�1 p„�� St� �, <br /> Where did waler enlering building come from? 0 SURFACE FLOW ❑GROUNDWATER�SEW'cR 84CKUP-FIXTURES Q UNKNOWN <br /> Delails:��,�rn.. cC �jl int�,o OS�y� P�Jl1 fJ it�c �a[�l«! /YK'n aL 71a� sl1L'2VY�Ji/l� <br /> Where did water go within lhe b�ildirg7 ��ASEMENT PERIh1ETER ❑BASE�dENT NEAR FIXTURES ❑OTHER <br /> Details�.�y^�'_-�rnc S/� � oF �uY l.crYix- /✓I�I�Nv Nh►r FD. •— 3��i+L�i,p <br /> Site Observations: -/ <br /> DownspouU sile graAing issues noted�_ J t� S�� n��1Ccf7�� fiLTi �d'f.1 _ _ <br /> Building eleea6on�elalive lo sewer and surrounding area issucs noted:�(� ✓�✓aT�"Pr o1 IltM / �?s*�2t <br /> rr <br /> Site pump issues noteti:�((�� <br /> Historical Information I Other�nformation: <br /> Prewous'flooding'issue Service Requesls at address: <br /> Previous'fioafin�"issues uo;^d by hamca�+mer. �p <br /> Recent slormwaler!sewer projecis compleled in a�ea: �j Proposed slormwater 1 sewer projecls in area�!1 <br /> Property owner interesled in heginning City Backwatr.r Valve Program at address:(�YES �NO Details: <br /> Netes: <br /> I A �!(Il� �7� DK✓Ym!' �a(h�rf �e�iL�� <br /> �rnl�� a tl Ci 1"CtOY'c�I o�l 7�d,/r!f?f��/0�/'Mi7l 872. <br /> Revision:3 TRW 1 Thursday, Sep[ember O5,2013 <br />