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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> Date of inspection: q`0✓( 3 Inspected By: (-2 arif ►"Loei1 <br /> Address: ' , I /c �I(�T PL. Service Request Number: CO I 8c ' <br /> Resident: e,tr-6 ( 1 elcizyn Owner? YES ❑NO <br /> Phone Number: �1 � e ® Vh/ Email: <br /> General Building Details: <br /> Is this building within the combined sewer area? In YES NO Does the building have a basement? ❑YES lj NO <br /> Does the building have a backwater valve(BWV)? ❑YES NO (If yes)Was BWV installed through City program El YES NO <br /> Does the building have a sump pump? ❑YES L‘10 Does the building have a grinder pump? ❑YES NO <br /> Storm Event Details: <br /> Where did water entering building come from? SURFACE FLOW ❑GROUNDWATER ❑SEWER BACKUP-FIXTURES ❑UNKNOWN <br /> Details: (AV¢C ru(Ns from (`off(� b'rU 1'\-2 r kJ` leas fi r�l ru,s A1vu�, <br /> Where did water go within the building? ❑BASEMENT PERIMETER ❑BASEMENT NEAR FIXTURES [THER <br /> Details: h 56'4 �..��u I-� krc I r^ C (QC n� r OCTlD ui <br /> r <br /> Site Observations: 1 <br /> Downspout/site grading issues noted: S S } I O u F r ef� /`N`'+U r h 1 Tin 6De- �3 ' L./GIr <br /> �10„�S a AIL I7a.,01L„/) k N c.orne <br /> Building elevation relative to sewer and surrounding area issues noted: kt,t0+2. seaci <br /> Site pump issues noted: 'V tr <br /> Historical Information I Other Information: <br /> Previous"flooding"issue Service Requests at address: 1CS <br /> 3 Previous"flooding"issues noted by homeowner: O �� ° `� te t'L) 1 0 1 eof <br /> Recent stormwater/sewer projects completed in area: °U6 Proposed stormwater/sewer projects in area: <br /> Property owner interested in beginning City Backwater Valve Program at address: ❑YES el NO Details: Nc ''ve-`2 <br /> Notes: ) Si t)� `,W " f l ro4 (t1 u 1 I f ' °,51 <br /> +Le- c ?os VZ,cil B 11 ue C etivr—c <br /> (5,Ar `' ii2Sk I t � e0.1 1^ \VS Mu 6-0 n <br /> Revision: 3 TRW 1 Thursday,September 05, 2013 <br />