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0 2013 LARGE STORM RESPONSE PAPER FORM CHECKLIST <br /> Date of inspection: io/) 1 Inspected By: (30 t/t't /\)00 6., <br /> Address: ----?t g L_V i-e----r 1.7s---- Service Request Number: <br /> Resident: Dl UJ((cSS 1 d� ( f ilvd/.. / COIN Owner? YES ❑NO <br /> Phone Number: Email: <br /> General Building Details: <br /> Is this building within the combined sewer area? ❑YES VINO Does the building have basement? YES ❑NO <br /> Does the building have b water valve(BWV)? ❑YES 0 NO (If yes)Was BWV installed r gh City program 0 YES 0 NO <br /> Does the building ha a sum ump? 0 YES 0 NO Does the building have a rinde ump? 0 YES 0 NO <br /> Storm Event Det ils: <br /> Where did water entering building come from? SURFACE FLOW 0 GROUNDWATER ❑SEWER BACKUP-FIXTURES 0 UNKNOWN <br /> Details: t I ,cT(-e. <br /> Where did water go within the building? 0 BASEMENT PERIMETER 0 BASEMENT NEAR FIXTURES ❑OTHER <br /> Details:girtra." <br /> t . <br /> Site Observations: <br /> Downspout/site grading issues noted: 1 1 r23 <br /> Building elevation relative to sewe and surrounding area issues noted: 1---9t/ i _( '/ L �i41 • <br /> Site pump issues noted: ( 4 <br /> Historical Information I Other Information: <br /> Previous"flooding"issue Service Requests at address: /n)2— <br /> Previous"flooding"issues noted by homeowner: /rUh 12 <br /> Recent stormwater/sewer projects completed in area: 11K9._ <br /> Proposed stormwater/sewer projects in area: <br /> Property owner interested in beginning City Backwater Valve Program at address:0 E NO Details: <br /> 7 <br /> Notes: rvaiscreeT, 1^-A ra_rava �i �rI S Sri . <br /> . <br /> 7 s i`, Tito S e 1 - (-ur - ?P $ Rl,,r`( (Slcemgt() l 'i"`"c/G,`/ls <br /> , - 'ot 1 C(4i/kic f ti r Co h`ri`Es (3 f`r <br /> Revision:3 TRW 1 Thursday,September 05,2013 <br />