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2013 LARGE STORM RESPONSE PAPER FORi�I CHECKLIST <br />Dale ol inspeclion:� Ui ?� Inspecled By� �C-�-fYl�rn�OYJ-l✓� i'L �1 <br />Address: �'^i"� (,J FT'mnP�= __ Service Request Numbec,[ 6�'�':."]_ _ <br />Resident: TL�C "' �� ����"i �7b O�vner9 �YES ❑ NO <br />Phone Number _��,,�j�� �Q�—�J�_�Lf,,T — Email: <br />G¢neral8uilding Details: <br />�s this building wiUiin ihe combineA se�ver area? �]c YES � NO <br />Dces the huilding have a backwaler valve (BWV�? � YES 0 NO <br />Dces the huilding have a sump pump? � YES 0 NO <br />Storm Event Details: <br />Docs Ihe building have a Uasement? f� YES � NO <br />(II ycs) Was BWV insta!led ihrough Cily program � YES bQNO <br />Coes Ihe buiiding have a grinder pump7 Q YES � NO <br />Where did viater entering building come Irom? ❑ SURFNCE FLOW L] GROUNDWA7ER �SEWER BACKUP - fIXTURES (] UNKNOWN <br />Details: �[�,K t �P TNPoi �h�a �= i rnQ_1.r=p.L�r_� + %' � � t�` ,� '—��_x_��� <br />Where did water go wilhin Ihe 6uilding7 �OASEAIENT P[RIMETER 0 9ASEMENT NEAR FIXiUR[S [j OTHER <br />De�ails: '% -� i�� i 7GPs'r_LCU=r�_�-�O�t�t._a_P__i n+_rty-s� F'n�1���:_t'�.� JL`�I�L�GN�'" <br />Sile Observalions: <br />Downspout 1 site graAing issues noled: _(_xL;r Ft� ��1��TT..M��GQ1'r1:C� �_L�U��.l��4?[�..�� =?—�-��1� <br />duildiny elemlion wiative lo sewer and sunounding erea issua naled. <br />Sitc pump icsues noled: �-�_7_u[y�(� ��L}i1'l�Jl�K�EL4.��e��F:1=1JN-!�--1.�-�- N-t�—tr��� 7-Q <br />C.vu�Li � W�fc�'. <br />Historiwl Inlormalion I Other Inlortnation: <br />Previous'lloodii ,' issue Servitc Rcquesis al add�ess: _��� .`_�u-� f�QC28,`�G � <br />Previous'lloodin j issues noled Ay homeowner. �UZf=_flC..L�._ELl7.�_IN_s1l..L(�.�1C.�-1LJ �� � — <br />Recenl stormwate� I sewer projecls compleled in area: Proposed slonnwater / sewei piojecls in mea. <br />Prnpedyowner iNeresled in beginning City flackwater Valve Program al address'. 0 YCS ❑ NO Delails�. <br />Nmes: _JJJ.l�1.K'�c�A�'r� �/��-YE_.(.��L[�E-n »—L-�F��.�c�i_��N'-�L'F.�S�— <br />.-In-LZC�CzC7_, `r--�.�n•, ; � �-JF�v� L=Q-�-, <Jn <br />lievision: 3 7NW 1 Monday, Seplember 09, 2013 <br />