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• <br /> 2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> 477. <br /> Date of inspection:"/14/1,-3 Inspected By: L'1 p J/!L"`, <br /> Address: 0,5— f-e , Service Request Number. <br /> Resident nj j C ‘Y>t I GAD Owner? iiS El NO <br /> Phone Number: Email. <br /> General Building Details: <br /> Is this building within the combined sewer area? YES ❑NO Does the building have a basement? YES El NO <br /> Does the building have a backwater valve(BWV)? YES ❑NO (If yes)Was BWV installed through City program Ell YES ❑NO <br /> Does the building have a sump pump? ❑YES <br /> ,k]NO Does the building have a grinder pump? ElYES [(NO <br /> Storm Event Details: �� / \ <br /> / r <br /> Where did water entering building come from? SURFACE FLOW El GROUNDWATER IL!' WER WER BACKUP-FIXTURES ❑UNKNOWN <br /> S �' n • � iDetails: s =!/ Nat , <br /> Where did water go within the building? r BASEMENT PERIMETER laiASEMENT NEAR FIXTURES El OTHER <br /> Details: rl.1-;ra- 'J e7y1 <br /> Site Observations: / �,/ <br /> Downspout/site grading issues noted: g P-- (3Gt,r!<f t1 tt Tar- 17 , ����e__, 2 k p4..el `o t r2l ?01bSZ ' i' <br /> Building elevation relative to sewer and surrounding area issues noted: t3da ivt ail i in e�/1(J g-44''e <br /> Site pump issues noted: <br /> Historical Information l Other Information: f � /_ <br /> ri <br /> Previous"flooding"issue Service Requests at address: -/) (kr) �- /-c la <br /> Previous"flooding"issues noted by homeowner: I3v7ki S 7�/</'n� <br /> Recent stormwater/sewer projects completed in area: Proposed stormwater/sewer projects in area: <br /> Property owner interested in beginning City Backwater Valve Program at address: ❑YES 0 NO Details: <br /> Notes: v`'-I l// 6 Srle"'e pbp-rn 2 (- (- 1)0,617 de.'i6 vc44 l - <br /> ce , - (..on 7A,�e t (JG v IA-S f /� 004'1 (4-)c(z <br /> Revision:3 TRW 1 Thursday,September 05, 2013 <br />