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__ _ -_ _ _ ____ _ _ _ _ _ -i <br /> 2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> I <br /> << .- c <br /> Dale ol inspeclion:�j � Inspected By: . G���u��-- <br /> Address:� 7�z �Qitir_�t GJi v� Service Requesl Number. <br /> Residenl: ��' �/� S ��/I`C���/�-µ^ Owner? ES �NO <br /> Phone Number. EmaiC <br /> General Building Details: <br /> Is ihis 6uilding aithin Ihe mmbined se�ver area? LI YES ❑NO Does the building have a basement? YES ❑NO <br /> Does the building have a backwater valve(BW1�? �YES �0 (If yes)Was BWV inslalled through City program ❑YES �N0�(�,�-- <br /> Ooes the building have a sump pump7 �YES �.Wd" Does the building have a grinder pump? ❑YES�Rf <br /> Slorm Event Details: r'/. _� Q"Yu r� <br /> �((Jlr <br /> Where did waler enlering buildinq come from7 ❑SURFACE FLOW ❑GROUNDWATER �'S�tieR BACKUP-FIXTURES ❑UNKNOWN <br /> oeta�is yP � /z i I G,� f r l /�' �u..z�r'o--''� -- Gvr.��- dG���a�i� <br /> Where did ualer go within the building? ' SEMENT PERIId�ETER �BASEMENT NEAR FIXTURES ❑OTHER l�l�°f/ih'� <br /> Delails' <br /> i <br /> Site Observalions: � <br /> Downspoul lsite grading issues noted: O �` �'�� ��lTL� lt�c�LC <br /> Building elevation relati�e lo sewer anA surrounding area issues noted �G' �tf/�t r� / �`D��U � <br /> u <br /> Sde pump issues noted: i✓�i�- <br /> Hislorical In(ormation I Othcr Informalion: <br /> .}- 1 <br /> Previous'flooding'issue Servite Requesis al address: ��'��r � � K'`y' �. � (��5�� `�e° <br /> Previous'tlooding'issuesnoledbyhomeowncr �. 0 G ��� C 1 i�n �� 1 1.((/,p/ �S �J � `� <br /> Tr— �l�i. r'c<•�v'—'. <br /> Recent slormwaler 1 sewer projects completed in area: Proposed slormwater/ ��p �ecis m area:�_ <br /> P�operty o�mer in�eresled in beginning Cily Backwalcr Valve Prot�ram at address•❑YES �N �� elails_ <br /> Notes. _ <br /> Rrvision: 3 TRW 1 Thursday,Seplember05,20]3 <br />