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. - -- -- ... - - — -. <br /> 1 <br /> 2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> c.> > � F. r'>.: .'u... <br /> Dale of inspeclion: ��� I� '� Inspected By: �'� .�•<<�/'� <br /> Address: �� r I , n'1 F 05 r D"7n/� %Z �i✓Gl4�r�'$erviceRequeslNumber: <br /> / <br /> Residenl: _ Owner? YES ❑NO <br /> Phone Numbcr. l'� � !r' � «<. __ __Email: �`D���'�- G� /.1("� / �"«ir� <br /> Gs.:eral Building�etails: <br /> i IIs Ihis buiiding within Ihe comb�ned sewer area?��C YES �NO Does Ihe buiiding have a basemenl?�[f YES ❑NO <br /> ,,_,/ i I <br /> 9 ( I /L�A ( Y 1 9 h'P�9 �� � <br /> Does Ihe buildin have a back�va�er valve BWV 7 ❑YES NO II es Was BWV inslzlled Ihrou h Ci r ram ❑YES �NO I <br /> Does Ui?builAing have a sump pump�/��YES �]NO Does the building have a grinder pump? �YES�❑?NO / � <br /> �""� 1`i'�" �L.r.tU-l`i" yl. %L:. f/d-✓��' %�0� ' / !i4 : ( �. <br /> �V <br /> Storm Event Details: � J +�G� ,' <br /> 7a <br /> Where did water entering�uilding come hom7 ❑SURFACE FLOW �GROUiJDWhTER EWER 6ACKUP�PIXTURES ❑UNKNOWN I <br /> / ,,; � .��, ,�<<_ � � < t <br /> Details: ;��i� .Lur� o;�.f�ive. q�-�,t,�c f (�C� ��' -(-ii �.,{.r(��i'r� r-_ ,���-..,, �,.`i,.�� <br /> � <br /> � . � ; � I <br /> Where did waler go wilhin the building? ❑BASEMENT PERIMETER �BASEMENT NEAR FIXTURES 0 OTHER � <br /> Delails: '� � `�1 ��CWe�� Ll� �� z / <br /> il�� �ivayn;/ ��.�stY,� .�� s�,'� wc..�C ���' <br /> Site 06servations: <br /> 0 c,.t�.ers .� .�v�i pa.�.of �l�cr4.a.f ��� ��j S . <br /> C� f <br /> Downspout I site giading issues noled: T /� �Hr t� <br /> Building elevalion rclaGve lo sewer and su�rounding area issues noted: <br /> Site pump issoes noted: _ <br /> s;::/ r'vc N"a <br /> Historicallnfotmationl0lherinformalian: �`G���fS� ft.�.�:� ,.���{ • /t_J — G�'��5�-�-� ly�..��y�.�_ � <br /> Previous'lloaling'issue Scrvice Requesls al address <br /> Previous'Oooding'issuesnoledbyhomeowner: 7te a�/'G� <br /> .Sr,vz✓,� <br /> Recenl stormwaler I sewer projeds wmpleled in area: ���� Proposed slormwaier I sewcr piojeGs in area: <br /> r <br /> Pmpedy owner i�rierested in b>ginning City Backwaler Valve Program al address❑YES Q N�D^Delails <br /> Noles <br /> /�L� c.(QCti✓t N�?,�-�X S � �lL �C l,v�— .�1� i <br /> � '-S�I.e�i 8-i-, . <br /> Revision:3 TRW i Thursday,September05, 2013 <br />