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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> j <br /> Dateotirspeclion; 2 InspecledBy:��! Il/m (�(J��U/� _ ! <br /> Address: ���' �e r���� Service Request Numbe� __ _ <br /> Residenl: S�� Va�� �77 �� Owner? V YES ❑NO <br /> Phone Number. Email:__. . . <br /> General Building Details: <br /> Is lhis building wilhin Ihe combined sewer area7 �'YES ❑NO Does lhe bwlding have a Dasement? �rE���� �/��„g y <br /> � j�u <br /> poes Ihe building have a 6ackx•afer valve(BWV)T u Y�S �NO (If yes)Was BVJV instalied thwugh City pmgram �YES 0 NO <br /> Does Ihe building havc a sump pump? ❑YES�]NO Does Ihe building have a grindei pump? �YES�'NO , <br /> I <br /> Storm Event Delails. <br /> Where did water entering buiiding come(rom? �SURFACE FLOW �GROUNDWATER i SEWER BACKUP-FIXTURES �UNKNOWN <br /> Delails: 1 ING� � �' �� • V �" ` <br /> Wheie did waler o wilhin Ihe 6uilding? BASEMENT PERIMETER I�J BASEh4ENT NEAR FIXTURES ❑OTHER <br /> Details:,�' i �..- l� �! �CJ�- N��T /1�'� • <br /> � SiteObscrvalians: <br /> , Downspoul/silegradingissuesnoled: ____ ____ _ <br /> Building elevalion relalive to sewer and smiounding area issues noted �U//�'il,�-- �1 /'�G (��-(/�'i ' <br /> � <br /> j Sile pump issues noted: <br /> iHistorical'nformationl0therinformation: <br /> � Previous"Ilooding'issue Service Requesls al aAdress: <br /> f 1I / /�� <br /> � Previous'flooding"issues noted by homeowner.L �� Y� � d �.(�-� ( O�.f T�(.�c Tr�„ M/..u� (,4'l��7. _ <br /> IRecenl siortnwaler/sewer projects compleled in area Proposed stormwaier 1 se�ver pro�eds in atea: <br /> I <br /> ; Properly owner interes�ed in beginning Gry Backwaler Valve Program al address:�YES Q NO Delails: <br /> i Noles ��GP� INk�.�.� I/�e„� a 'C,�i��'�/�GL G!'pt t�'k�S !yQ �'1F.S h Prir�f �L'� ^ ' .�c eU= <br /> �,�� vw�� (,�,���� DF ����.)� ,'y <br /> CCo�,, /l��r F� � l3�Il. ,L(/e-e�r{- ,l�-� s�-ce. i, c�-, <br /> ' Revision:3 TRW 1 MonAay,September 09,2013 <br />