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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> 5. <D�d ICI C.�• "u y�'1'l <br /> G <br /> Date of inspection: / //6 Inspected By: ° 5-4.cl�� <br /> Address: (91 j ,rr Service Request Number: <br /> Resident: /--7�C- /'G`t ' Owner? afES ❑NO <br /> r / ) <br /> Phone Number: 3 l q 3 0 Email: 0 �� ` � �c. <br /> General Building Details: <br /> Is this building within the combined sewer area?OES ❑NO Does the building have a basement? YES ❑NO <br /> Does the building have a backwater valve(BWV)? ❑YESj2110 (If yes)Was BWV installed through City program ❑YES grNO <br /> Does the building have a sump pump? ❑YES, NO Does the building have a grinder pump? ❑YES "NO <br /> Storm Event Details: � .: G-r/,/V1,g.f c� <br /> Where did water entering building come from? ❑SURFACE FLOW ❑GROUNDWATER lErSIVVER BACKUP-FIXTURES ❑ UNKNOWN <br /> Details: fe t '^�& (- � ,t d� G ^ } /r-k a r ( 4, ,ft Where did water go within the building? ❑BASEMENT PERIMETER ❑BASEMENT NEAR FIXTURES ❑OTHER <br /> Details: <br /> Site Observations: P-d GC��r G�.o i ' �) 3-6J <br /> Downspout/site grading issues noted: /�Oirr S t) >' t'`t'6,1 CAA, <br /> ` ' trk.,Ce <br /> Building elevation relative to sewer and surrounding area issues noted: <br /> Site pump issues noted: /Wig- <br /> Historical Information I Other Information: <br /> Previous"flooding"issue Service Requests at `-( 1address: l <br /> 1/ Yt\ 5:7(C ! G G ��2 n /� <br /> Previous"flooding"issues noted by homeowner: 12-fl �� ` �`�`'� <br /> Recent stormwater/sewer projects completed in area: /L Proposed stormwater/sewer projects in area: <br /> Property owner interested in beginning City Backwater Valve Program at address: ❑YES ❑ NO Details: <br /> Notes: <br /> Revision: 3 TRW 1 Thursday,September 05,2013 77//3 <br />