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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> Ev <br /> Date of inspection: Inspected By: <br /> Address: Service Request Number: <br /> Resident: Owner? ❑YES ❑ 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 ❑ 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 ❑ NO 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: <br /> Where did water go within the building? ❑ BASEMENT PERIMETER ❑ BASEMENT NEAR FIXTURES ❑ OTHER <br /> Details: <br /> Site Observations: <br /> Downspout/site grading issues noted: <br /> Building elevation relative to sewer and surrounding area issues noted: <br /> Site pump issues noted: <br /> Historical Information I Other Information: <br /> Previous"flooding"issue Service Requests at address: <br /> Previous"flooding"issues noted by homeowner: <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 />