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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> Ev <br /> Date of inspection: g 0 S rvUs,-7,2_ ZD►3 Inspected By: tJ l tug TK bSs 12,cy t-tA 1.2-1 5 <br /> Address: S l,2_ A-L?i t — 1R_ Service Request Number: <br /> Resident: N1.IkT i i OK L -1 Owner? VYES ❑NO <br /> Phone Number: 142-S. Z t l'. 66 15 OS Email: .JTFz-(7t1r PIS/4-1Q0 PADP.?`L Pt-14I') (a)►1_ <br /> General Building Details: <br /> Is this building within the combined sewer area? ❑YES ❑ NO Does the building have a basement? ❑YES NO <br /> Does the building have a backwater valve(BWV)? ❑YES ❑ NO (If yes)Was BWV installed through City program ❑YES ❑ NO <br /> Does the building have a sump pump? ❑YES [ tc10 Does the building have a grinder pump? ❑YES ❑ NO <br /> Storm Event Details: �,� <br /> Where did water entering building come from? l�SURFACE FLOW ❑GROUNDWATER ❑ SEWER BACKUP-FIXTURES JNKNOWN <br /> Details: StT?— Sio 'r 1 uouSTZ ISUErrAt z_ R.00F tuuoc oD1-17,D ATE t70-kNS 4 rAJt=errn yaw ie_ <br /> Ft o o(? O tAtkRa... 1.iN Vt Lc. ftnkt (SPcLa .) frfl- '. (.4X) TIN <br /> Where did water go Within the building? BASEMENT PERIMETER L I BASEMENT NEAR FIXTURES THER <br /> Details: 'PzMFi'L O Q Ato— Docse... 111/4rD Utur2_ LirrA/T-i. f-tousg — 6Atti V.novvt ST2)0 fl-A*, 1 b <br /> Site Observations: <br /> Downspout!site grading issues noted: ACL?z.So&- (Sub 6-S /I am,Sir- D SLAWS t'Dc1T'S OUFzlt_.LoAOFg-D Dt2.4nJ SYSr M <br /> $ ©UV.-2R.ow 1w TO t�t,oc�S� <br /> Building elevation relative to sewer and surrounding area issues noted: bit bt-t IZ.. <br /> "�tA ) Stz fp& <br /> Site pump issues noted: 1Ihk. <br /> Historical Information I Other Information: <br /> Previous"flooding"issue Service Requests at address: t' i tJ'z. tJ'Di'i=r.C7. <br /> Previous"flooding"issues noted by homeowner: k OUS_ • <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 ❑ NO Details: <br /> Notes: <br /> Revision: 3 TRW 1 Monday,September 09,2013 <br />