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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> 14,a��1r <br /> Date of inspection: 7 l 3 Inspected By: <br /> Address: 4/2We -1.,e/1/LGI--C.&___ Service Request Number: <br /> Resident: 1Ch /�!\�-�al Owner? ❑YES El NO <br /> Phone Number: Email: Rib e n t*Ccerptc '� <br /> General Building Details: <br /> Is this building within the combined sewer area? YES ❑NO Does the building have a basement? ES' El NO <br /> Does the building have a backwater valve(BWV)? El YES (If yes)Was BWV installed through City program ❑YES ❑NO "— <br /> Does the building have a sump pump? ❑YES [ 40 Does the building have a grinder pump? ❑YES NO <br /> Storm Event Details: <br /> Where did water entering building come from? El SURFACE FLOW ❑GROUNDWATER El SEWER BACKUP-FIXTURES ❑UNKNOWN <br /> Details: IVO �e J G- /1-Atir <br /> Where did water go within the building? ASEMENT PERIMETER BASEMENT NEAR FIXTURES ❑OTHER <br /> Details: kt 74 T !lti P'D— -110 /oz. f L d•�`-- <br /> Site Observations:Downspout I site grading issues noted: ��(,1/& f 006 1 0 47 G .175 Z2 iGic,/ <br /> Building elevation relative to sewer and surrounding area issues noted: ?Go < dpetF� t S�C.�-� Pta T <br /> Site pump issues noted: <br /> Historical Information I Other Information: <br /> Previous"flooding"issue Service Requests at address: <br /> Previous"flooding"issues noted by homeowner: <br /> Recent stormwater I sewer projects completed in area: Proposed stormwater I sewer projects in area: <br /> Property owner interested in beginning City Backwater Valve Program at address: ❑YES ❑ NO Details: <br /> Notes: 1/ r ram;r d;P/I,vi coi'damk,&ale, ipAgti+teA.4 <br /> 7a4/16 <br /> 1 <br /> Revision: 3 TRW 1 Thursday,September 05, 2013 <br />