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2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> grr • <br /> Date of inspection: I V V /T Inspected By: /70:Ail b OA rt <br /> Address:6 L1-./ (.�v�.rcC4Wn r-'a / Service Request Number: <br /> t <br /> Resident: Owner? ❑YES Ig9 NO <br /> Phone Number: Email: <br /> General Building Details: <br /> Is this building within the combined sewer area? ❑YES V Does the building have a basement? 151 YES ❑NO <br /> Does the building have a backwater valve(BWV)? ❑ ❑NO (If yes)Was BWV installed through City program ❑YES ❑NO <br /> Does the building have a sump pump? ❑Y ❑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: g'f-dr PWC ei41- 1 (i f Prci —? is S4r70d- ht' 46 es 7= 4 f Pl. r--- <br /> Where did water go within the building? ASEMENT PERIMETER DICASEMENT NEAR FIXTURES ❑OTHER <br /> Details: 1-.--::—i(%1 C e 0 --- /y47 Ix 1 s h�`.{�i�i / :'J///4i - <br /> Site Observations: <br /> Downspout/site grading issues noted: (A ir\ TO 6-rit-vvt 9) 1-4/ Pr;Val(2- <br /> Building elevation relative to sewer and surrounding area issues noted: 1-/-6/ ub .i _ <br /> Site pump issues noted: <br /> Historical Information/Other Information: <br /> Previous"flooding"issue Service Requests at address: <br /> Previous"flooding"issues noted by homeowner. 11,ri <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: ppIL-G,rs J L- pc t)(- 7L .Q_ it-e-t�a/ 2-2 5 -fAAa- <br /> Revision:3 TRW 1 Thursday,September 05, 2013 <br />