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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> r**%//--A <br /> /3 .L /cati., C, e i'op'-,'ZI <br /> Date of inspection: 9'/ ' Inspected By: i1 c 5 ��'' <br /> Address: 60 7- //l/Lrra Service Request Number: <br /> Resident: f r ./I A-41c 4"A"- Owner? ®'YES ❑ NO <br /> Phone Number: '-(' C 5 C -. 1 / Email: ..... Nor a- r-U\ \I c- 0 , `\ <br /> C <br /> General Building Details: <br /> Is this building within the combined sewer area? YES ❑NO Does the building have a basement? YES ❑ NO <br /> Does the building have a backwater valve(BWV)? ❑YES 3 NO (If yes)Was BWV installed through City program ❑YES RKQ'rr/ <br /> Does the building have a sump pump? E ES ❑NO 1 Does the building have a grinder pump? 'ES,❑NO <br /> ;20 ✓l S 1‘64t- ir(00 ✓ ffGt ;P? <br /> Storm Event Details: <br /> Where did water entering building come from? ❑SURFACE FLOW ❑GROUNDWATER ❑SEWER B KUP-FIXTURES ❑ UNKNOWN <br /> Details: Wa.,3 vim' c%(l/Gt-2! l leh..-.-- 4 v-2-_- 1--( ( 0 d VP- <br /> Where did water go within the building? SEMENT PERIMETER ❑ BASEMENT NEAR FIXTURES ❑OTHER <br /> Details: fc.c , f' f viz s,.__ u S"�-�- <br /> Site Observations: Q lam. ``` r .t FG xl� _;-4- <br /> Downspout/site grading issues noted: I0 t - t. (/R J I-u-'c.i v -L a `i <br /> Building elevation relative to sewer and surrounding area issues noted: ` f P <br /> Site pump issues noted: SLA T pu y et- it p P am--- " a 0("-'` --e./(7-4-( <br /> pcam(a~ (./ S <br /> Historical Information I Other Information: <br /> Previous"flooding"issue Service Requests at address: 4 6 <br /> Previous"flooding"issues noted by homeowner: r'A 0\--�)---- <br /> ,- `- <br /> Recent stormwater/sewer projects completed in area: �`1 6 Proposed stormwater/sewer projects in area: <br /> Property owner interested in begin,ing City Backwater Valve Program at address: ❑YES ❑NO Devils: �� <br /> Notes: CG c r < e c cn�.a-_ I <br /> Revision: 3 TRW 1 Thursday,September 05, 2013 <br />