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0 2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> Date of inspection: Y/t / Inspected By: tAl t Soli t"."#-. <br /> Address: 7 F-// �i/i' / / Service Request Number: 'a /2 3 eV <br /> Resident: e 0 Po v / Owner? EE i ❑NO <br /> Phone Number: Email: <br /> General Building Details: �- <br /> Is this building within the combined sewer area? ❑YES aN. Does the building have a basement? 'ES ❑NO � -2 <br /> Does the building have a backwater valve(BWV)? ❑YES ❑NO (If yes)Was BWV installed through City program CI YES ❑NO <br /> Does the building have a sump pump? ❑YES CI NO 5 7 Does the building have a grinder pump? ❑YES ❑NO <br /> Storm Event Details: <br /> Where did water entering building come from? 2111TRFACE FLOW ❑GROUNDWATER ❑SEWER BACKUP-FIXTURES ❑UNKNOWN <br /> Details: r rr) Wcce- r 1—4-✓ 61 OtAx-A- r ,62-1/9{z/f/irp ide /0 W.tA_.- ce,rr :.c._ <br /> Where did water go within the building? 0 BASEMENT PERIMETER ❑BASEMENT NEAR FIXTURES DIM-HER ,ter 5 Gt <br /> Details: <br /> Site Observations: <br /> Downspout I 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: ii9s" ..' ' ' .`, l- 20•3 <br /> Previous"flooding"issues noted by homeowner: <br /> Recent stormwater I sewer projects completed in area: `-- Proposed stormwater I sewer projects in area: <br /> Property owner interested in beginning City Backwater Valve Program at address:❑YES 0 NO Details: <br /> Notes: ›4" G r -4c. dew 14.E .E A e f t,z--, (41- <br /> F/ 1-‘ r 0 7 k 1 a r- ---- 'C' Lvt,e Gt_de tr`4c, a 5'; 1.44 <br /> f <br /> y <br /> 4• CA.—--- 41 <br /> 4 its' .t ,, .P._. l"`er'-444, <br /> Revision:3 TRW 1 Thursday,September 05, 2013 <br />